“What other option did I have?” – The effect of conflict and displacement on child marriage and early childbearing among displaced Rohingya adolescents

“What other option did I have?” – The effect of conflict and displacement on child marriage and early childbearing among displaced Rohingya adolescents | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “What other option did I have?” – The effect of conflict and displacement on child marriage and early childbearing among displaced Rohingya adolescents Kate Mieth, Tahia Hasan, Adrija Chakrabarty, Kenna Lee, Adrita Kaiser, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4952569/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Mar, 2025 Read the published version in Conflict and Health → Version 1 posted 9 You are reading this latest preprint version Abstract Background. Humanitarian emergencies are postulated to increase rates of early marriage and early childbearing, as drivers of both are heightened or exacerbated in crisis settings. There is a critical need for research that explores the causal mechanisms that motivate family formation, i.e. the process from marriage into childbearing, and how this process is affected by conflict and displacement. Objective. This paper aims to describe how displacement and living within a camp context has affected trends, norms, and drivers around family formation, focusing on the lived experience of female and male adolescents and young adults aged 15-24. Methods. We coded and analyzed qualitative data from forty-nine in-depth interviews and sixteen focus group discussions conducted with Forcibly Displaced Myanmar Nationals aged 15-24 who arrived in Cox’s Bazar during or after October 2016. Results. Participants agreed that rates of child marriage have increased post-conflict and displacement and generally attributed this increase to a variety of drivers, including fears around protection, socioeconomic need, lack of education and/or employment opportunities, and a perceived loosening of restrictions around legal age of marriage within camp. While some of these are pre-existing drivers exacerbated by conflict and displacement, others are new drivers that have developed as a result. The ways that adolescents experienced each driver were also highly gendered. Conversely, conflict and displacement had seemingly little effect on cultural expectations to demonstrate fecundity immediately after marriage. Finally, participants felt that adverse living conditions within camp have significantly lowered fertility intentions and have increased adoption of family planning. Conclusions. Our results demonstrate that many Rohingya families currently view child marriage more as a practical tool to overcome challenges associated with being displaced, and early childbearing as an inevitable natural consequence of child marriage. The Bangladeshi government must ease restrictions on educational and livelihood opportunities for both adolescent girls and boys, who otherwise have no alternatives to child marriage, and few other opportunities to thrive and productively contribute to their communities. Family formation early marriage child marriage childbearing fertility fecundity humanitarian settings Cox’s Bazar Rohingya Forcibly-displaced Myanmar Nationals conflict displacement adolescent health BACKGROUND Child marriage, defined as a formal or informal union before the age of 18 ( 1 ), is generally considered a violation of human rights ( 2 ). Despite the existence of global agreements and laws intended to prevent the practice ( 2 – 4 ), approximately 19% of females globally are married before age 18, with 4% married before age 15 ( 5 ). Adverse consequences associated with child marriage include increased odds of intimate partner violence, restrictions on autonomous mobility, and discontinuation of education ( 6 – 9 ). Three percent of males are also married before age 18 globally ( 5 ). Though there have been fewer studies that identify the adverse consequences of child marriage for males, there is evidence suggesting it is associated with lower levels of educational attainment and less awareness on sexual health topics ( 10 ). Child marriage among females has consistently been associated with subsequent adolescent childbearing ( 11 – 13 ). External pressures for immediate childbearing, power structures within the family, normalization of risks associated with childbearing, protection concerns for young girls, and an increase in social status associated with having children all drive early childbearing ( 7 , 14 ). These drivers compound with adolescent girls’ physical immaturity and insufficient nutrition, leading to an increased risk of mortality and morbidity for adolescent mothers and their children ( 7 , 14 , 15 ). Early childbearing is also associated with higher lifetime fertility, again increasing lifetime risk for maternal morbidity and mortality ( 16 ). Though limited and somewhat mixed, current research suggests that rates of child marriage may increase in humanitarian emergencies, as known drivers of child marriage are heightened or exacerbated in crisis settings ( 17 – 21 ). Child marriage drivers that exist outside of humanitarian emergencies include economic uncertainty, lack of employment opportunities, and fear of sexual violence among unmarried women ( 22 , 23 ), all of which have shown to be compounded in emergencies ( 18 – 20 ). Despite the negative health and gender-related consequences that are associated with child marriage, the practice is often perceived to confer benefits, such as increased physical protection from sexual and physical violence and increased economic stability. In this way, child marriage may be used as a coping mechanism to overcome adverse secondary effects of conflict and displacement ( 22 – 24 ). However, humanitarian crises have not been universally associated with increases in child marriage ( 25 ). Thus, to identify effective strategies to reduce child marriage, it is critical to identify the specific trends and drivers within each local context that potentially increase demand for early marriage, and how displacement may affect these trends and drivers. There has been even less research on the direct links between child marriage and subsequent early childbearing in humanitarian emergencies ( 26 ). Qualitative research in non-humanitarian settings has described the pressure that many young women face from family and partners to demonstrate fertility upon marriage ( 7 , 27 ), but few papers have explored whether these pressures are affected by humanitarian emergencies. While limited quantitative research has shown that fertility behavior can be affected by exposure to conflict ( 28 – 30 ), the mechanisms through which exposure to humanitarian emergencies affects determinants of childbearing among adolescents has been largely unexplored ( 26 ). Evidence from displaced refugees has found that some women express the desire to limit childbearing, due to generalized uncertainty about the future ( 31 ), while others retain high fertility intentions regardless of displacement ( 32 ). These studies are non-specific to adolescents, however, and largely investigate changes in overall desired number of children, leaving questions about how humanitarian emergencies affect childbearing upon marriage unexplored. One population which has long suffered the primary and secondary effects of conflict and displacement is the Rohingya, who have been subjected to repeated discrimination, persecution, and violence by their home country of Myanmar since being deemed “stateless” in 1982 ( 33 ). Resultingly, the Rohingya have experienced mass displacement over several waves of migration and have long sought asylum in Cox’s Bazar, Bangladesh, which now houses the largest refugee camp in the world ( 34 ). In October 2016, violence from the Myanmar government heightened, and over 700,000 Rohingya fled to Cox’s Bazar throughout 2017 ( 35 ). However, Rohingya who fled in 2017 have not been granted refugee status by the Bangladeshi government and are instead referred to as “Forcibly Displaced Myanmar Nationals” (FDMN). Recent data indicate that displacement during 2017 may have increased child marriage ( 36 ), with approximately 14% of FDMN females age 18–19 married before age 18 and 9.4% of FDMN males age 18–19 relative to 13.3% of registered Rohingya refugee females and 0% of registered refugee males of the same age. Prior to displacement, the Myanmar government prohibited Rohingya from marrying before age 18 by law. Discriminatory practices within Myanmar included placing restrictions on marriage and birth registration of the Rohingya and payment of money to military authorities ( 35 ). Despite legal restrictions, however, cultural norms and traditions provided support for child marriage; as in other settings, marriage was viewed as a protective measure for girls, providing them with security and protection ( 37 ). Previous studies with the Rohingya have suggested that child marriage is driven by a variety of factors, including pre-existing religious and cultural norms ( 37 , 38 ), and others which are examples of issues commonly exacerbated by crisis and camp settings (incl. economic insecurity, increased protection issues, and limited enforcement of regulations protecting human rights ( 21 , 38 – 44 ). Despite general awareness that child marriage is punishable by law, there is also evidence that enforcement of these laws is perceived to be looser in Bangladesh than Myanmar, leading to higher potential for child marriage ( 37 ). Childbearing norms and drivers are less studied among the Rohingya. Evidence suggests that early childbearing is common; one study within Rohingya refugee camps found that 53.3% of females who married before age 18 had at least one child ( 37 ). Prevalence of early childbearing is consistent with current research, as the factors known to drive early childbearing, including increased practice of child marriage, taboos around sexual relations outside marriage, and perceived loosening of child marriage laws are all present in Cox’s Bazar, but very little qualitative research has been conducted regarding early childbearing among FDMNs in Cox’s Bazar ( 37 ). Even less research has been done to understand the childbearing desires and behaviors of Rohingya males, despite widespread acknowledgement that male childbearing preferences and desires influence that of their female partners ( 45 – 47 ). Given the complexity of the underlying drivers that affect both marriage patterns and childbearing within marriage, there is a critical need for research that explores the causal mechanisms that motivate family formation, i.e. the process from marriage into childbearing, and how this process is affected by conflict and displacement. This paper, which accompanies a quantitative paper establishing how rates of marriage and childbearing have changed amongst Rohingya FDMN adolescents, aims to identify and describe how displacement and living within a camp context has affected trends, norms, and drivers around child marriage and early childbearing, focusing primarily on the lived experience of female and male adolescents aged 15–24. METHODS A mixed methods study was conducted from 2021 - 2023 in Cox’s Bazar, Bangladesh. The quantitative component was conducted by Green Hill: Community Partners International (CPI) and the qualitative component was conducted by BRAC James P Grant School of Public Health (BRAC JPGSPH) with support from CPI. Both components were supported by faculty from the Johns Hopkins Bloomberg School of Public Health, Center for Humanitarian Health. Study Setting This study took place in Cox’s Bazar, Bangladesh, where one of the most populated refugee camps in the world, Kutupalong, is located. Cox’s Bazar houses nearly one million displaced Rohingya people (24, 23), of whom approximately one-third are FDMN, arriving after the latest wave of violence in 2017. Qualitative research was conducted in camps 1W, 4, and 17 of Ukhiya Upazila of Cox’s Bazar district, which were purposely chosen due to CPI’s previously-established community ties. The broader camp context is characterized by cramped living conditions, movement restrictions, and limited access to educational and employment opportunities (48–51). Data Collection Qualitative data was collected in March-April 2023. Initial participants were identified with the help of CPI who, given their wide community ties within the three camps, were able to recommend potential households where eligible adolescents were likely present. Members of the BRAC JPGSPH research team then approached these households, confirmed that eligible adolescents were present, and began conducting initial interviews. All following participants were identified and recruited via a snowball sampling method. Forty-nine (49) in-depth interviews (IDIs) and sixteen (16) focus group discussions (FGDs) were conducted with FDMNs aged 15-24 who arrived during or after October 2016 (see Table 1). Figure 1. Qualitative Study Participants by Method, Sex, Age, and Marital Status Method Total No. of Interviews / Groups Sex No. of Participants by Age Age No. married No. unmarried Totals In-depth Interviews w/ Participatory Timeline Activity 49 completed; 48 coded & analyzed* *one married male transcript was censored due to insufficient data Female 15 1 2 3 16 - 1 1 17 - - 0 18 4 1 5 19 4 2 6 20 4 1 5 21 2 2 4 22 3 1 4 23 - - 0 24 - - 0 Female Subtotal 18 10 28 Male 15 - - 0 16 - - 0 17 - 1 1 18 1 2 3 19 4 - 4 20 1 1 2 21 2 1 3 22 - 3 3 23 2 - 2 24 2 - 2 Male Subtotal 12 8 20 TOTAL – both sexes 15-17 1 4 5 18+ 29 14 43 All Ages 30 18 48 Focus Group Discussions w/ Participatory Venn Diagram Activity 16 FGDs conducted & analyzed (6-8 participants per group) 10 groups of married adolescents (6 female groups; 4 male groups) 6 groups of unmarried adolescents (3 female groups; 3 male groups) Female 15 - 3 3 16 1 2 3 17 3 1 4 18 5 5 10 19 5 3 8 20 5 3 8 21 9 1 10 22 6 1 7 23 3 2 5 24 3 1 4 Female Subtotal 40 22 62 Male 15 - 1 1 16 - 2 2 17 - 1 1 18 5 4 9 19 3 4 7 20 4 7 11 21 2 1 3 22 4 - 4 23 5 1 6 24 3 - 3 Male Subtotal 26 21 47 TOTAL – both sexes 15-17 4 10 14 18+ 62 33 95 All Ages 66 43 109 KII 24 conducted & analyzed Female 18-29 4 4 30-39 6 6 40-49 1 1 50-59 1 1 60-69 1 1 Female Subtotal 13 Male 18-29 - 0 30-39 5 5 40-49 3 3 50-59 3 3 60-69 - 0 Male Subtotal 11 TOTAL – both sexes and all ages 24 IDIs were conducted using a semi-structured interview guide and included a Life History and Timeline participatory method, in which participants were asked to outline what they considered to be the major events in their life from birth to present day. FGDs were conducted using a semi-structured interview guide and included a Venn Diagramming participatory method, in which participants were asked to rank how influential different individuals, community contexts, and local health programming are in decision-making around a variety of SRH topics, including child marriage and family planning. Both the IDIs and FGDs broadly focused on the SRH topics of marriage, childbearing, and family planning. The primary difference between the two methods was scope; the IDIs focused on the participant’s personal experience and opinions around these topics at an individual level, whereas the FGDs focused on discussing community-level beliefs and norms around these same topics. Considering cultural norms and restrictions around movement amongst Rohingya adolescent girls, IDIs for the female participants were all conducted within the participants’ residence. Two data collectors were present at the time of each interview, and researchers were instructed to conduct interviews in the most private part of the house and ask that family members allow for privacy. The data collector who was not directly conducting the interview was instructed to monitor for family members during the interviews and, in the case of interruptions, to engage them in discussions unrelated to the study until privacy could be re-established. In cases where having a private space within the home was not possible, the interviews were conducted in an area immediately outside of the home. Males were also interviewed at home, as well as at nearby tea shops, at the participant’s discretion. Because the FGDs required a long time and a specific setting so that the Venn diagrams could be conducted in separate age groups, FGDs for males, like the IDIs, were conducted at home or at CPI-provided training areas and FGDs for girls were conducted at one of the participant’s homes. Interviews with male participants were conducted by male Rohingya volunteers associated with CPI. Due to limited availability of female Rohingya volunteers, interviews with female participants were conducted by female volunteers from the host community who spoke Rohingya, were Bangladeshi nationals, and residents of Cox's Bazar city. All data collectors attended a five-day qualitative training workshop, which included pre-testing the qualitative interview guides in the field and making revisions for clarity and thoroughness per participant and trainee feedback. Five field supervisors were present during the data collection process to ensure consistent implementation of the research protocol. Interview guides were developed in conjunction with community advisory boards composed of a variety of local leaders within the Rohingya community and social and cultural norms were taken into consideration to ensure that phrasing remained neutral to minimize social acceptability bias. As Rohingya and English are the primary languages spoken by Rohingya volunteers working with local humanitarian aid organizations in camp, the interview guides were provided in both “Rohinglish” (a phonetic spelling of the Rohingya language using the English alphabet) and English, so that the volunteer data collectors were able to use both languages to conduct the interview as needed. Participants aged 18 years of age or older, as well as married, emancipated i participants under the age of 18, provided verbal consent prior to being interviewed. Verbal assent was collected from adolescents aged 17 and younger, in addition to verbal consent from either their parent or the eldest member responsible for the participant within the household. Ethical approval was provided by both The Johns Hopkins Bloomberg School of Public Health Institutional Review Board (FWA00000287) and BRAC James P Grant School of Public Health, BRAC University’s review board (IRB protocol no.: IRB-25 June’22-022). Due to widespread illiteracy and as Rohingya is not a written language, all participants provided verbal consent to participate. Data Analysis English-language transcripts along with observational notes were reviewed, coded, and analyzed using Dedoose 9.0.107. Researchers at Johns Hopkins University and BRAC-JPG independently read English-language interview transcripts, then discussed and developed a codebook using a blended coding strategy. The codebook was primarily composed of deductive codes informed by research themes identified during a previous research project conducted in Cox’s Bazar by this research team (25), and also used as a framework for crafting the interview guides. However, researchers also cooperatively added inductive codes that would otherwise not fit within the initially-developed codebook. Memo-writing and regular reflexivity exercises were performed to minimize bias, identify emerging trends in the data, capture relationships between codes and emerging themes, and to identify gaps in the data. During the analysis phase, the team met weekly to discuss progress and develop the overarching themes that developed across codes. Once the codebook was finalized, the remaining qualitative data was coded and summaries of the coded excerpts by each code group were developed to identify trends in the findings – including among participant subgroups by characteristics such as sex, marital status, age at marriage, and age at first birth. RESULTS To better understand how conflict, displacement, and living within a camp context has affected family formation among the FDMN community, participants were first asked about their perception of current norms and drivers of child marriage and early childbearing. The participant’s description then served as a frame of reference to discuss how they felt these current norms and drivers compared to the norms and drivers that they experienced and/or witnessed regarding child marriage and early childbearing prior to displacement. Current Norms Around Age at First Marriage There was near consensus that marriage should occur at or after 18 years of age. However, there was also clear differentiation as to the exact age range beyond 18 for females and males. Participants more often noted that, for girls, the “ideal” age of marriage was 18 exactly, whereas for boys the stated “ideal” age of marriage generally ranged from 18-22. A few participants mentioned community stigma around being an ‘older’ bride, though this stigma did not seem to apply to ‘older’ grooms: “People say bad things when [people] get married at an older age. If girls get married at an older age, people say they are older, but if the boys get married at an older age, they do not say anything.” -IDI23, female, unmarried, age 21 No participants said that marriage before age 18 was ideal, though a few did discuss reasons why they were personally married before that age. These participants most often cited financial insecurity, familial instability, or need for social or physical protection – themes which are further detailed below. Some participants went on to explain why they and/or the community thought 18+ was an ideal age for marriage. Most often, they attributed this preference to protecting the physical health of women (i.e. to prevent childbearing prior to age 18) and/or to ensuring that adolescents were old enough to be “ready” for the financial (in the case of males), emotional, and social responsibilities associated with married life. “If a couple gets married at that age [at age 18 or later], they will face no difficulties while having children; they will have proper peace in the house and will be able to handle everything. If a girl is married off before the age of 18, she will not have enough maturity about handling her emotions and treating the husband and in-laws the right way. When they turn 18, they grow this level of maturity to respect in-laws. That's why it is good to marry off the girls after turning 18.” -FGD15, unmarried male age 15-24 However, the discussion around “ideal” age at first marriage was not entirely consistent with the reported typical age at first marriage within the community; many participants shared that marriage before age 18 is not uncommon. Some participants also noted that not all community members view the consequences of child marriage as negative, nor wait until adolescents have turned 18 to encourage them to marry. “Some people say the girl would be too young to understand how marriage works [before age 18]. She won’t be able to do household chores properly and can’t solve problems. On the contrary, some don’t see early marriage as a problem. They believe a girl can learn how to maintain a family after marriage.” -IDI33, female, married at 17, age 18 Impact of Conflict & Displacement on Marriage Norms There was notable heterogeneity in views around the impact of displacement on community norms around child marriage. Some participants felt the average age of marriage had decreased after displacement, and that child marriages were more common now, despite camp authorities (known as the “Camp-In-Charge”, or CIC) enforcing laws preventing underage marriage. These participants most often explained this increase by communicating that there was a relative disregard for the laws restricting child marriage in Bangladesh, whereas they felt the laws which had regulated child marriage in Myanmar were more closely followed at that time. Other participants, though fewer, felt that restrictions on child marriage had instead gotten tighter since being displaced to Bangladesh, and that rates were dropping as a result. Many more participants discussed the impact that conflict and displacement had had on their own marriage. When married participants were asked if and how the conflict and their displacement affected the age at which they were personally married, the majority felt that they would have been married later had they remained in Myanmar. The reasons given were the relative permissiveness of child marriage in Bangladesh as compared to the restrictions in Myanmar, conflict-related security issues, lack of educational and employment opportunities within camp, and pressure from family members to marry – themes which will be discussed in greater detail, below. Most of these respondents were themselves married prior to age 18. This finding was consistent across genders. “If I were in Burma ii I wouldn't have gotten married early. We wouldn't have to leave Burma. In Burma, no one can marry before coming of age. But here we can do that with false documents. There are also security issues. No one knows what is going to happen tomorrow. This makes the parents very conscious and that’s why everyone is getting married earlier than they would have in Burma.” -IDI39, female, married at 17, age 18 Fewer participants said that they would’ve gotten married at the same or earlier if they had stayed in Myanmar, or that they didn’t know. Of the latter group, most felt that their marriage timing was “Allah’s wish”, implying they either didn’t have much personal control in the decision-making around marriage and/or it is not worthwhile to speculate because their life had, by-design, already gone according to “God’s plan”. “Interviewer: Would you have married in Burma at the same age you married in Bangladesh? Participant: Sister, it’s all about the Almighty's order. If he wanted, then it would've happened. Here Almighty's order came and then happened. Interviewer: You think you would get married there at that age whether you came to Bangladesh or not? Participant: I don't think about that. It's all Almighty's wish. If I had not come that year to Bangladesh, I might have gotten married in Burma.” -IDI30, female, married at 16, age 20 Current Child Marriage Drivers The most common current marriage drivers that participants discussed were protection from sexual, physical, and/or social harm, socioeconomic need, lack of educational and/or livelihood opportunities, and a perceived lessening of enforcements around minimum age requirements for marriage in Bangladesh as compared to Myanmar. While these themes were discussed by both male and female participants, the way that they were experienced by and applied to male and female adolescents were different, and gendered. Protection from Harassment, Assault, and Dishonor . Many participants found living conditions to be both unsafe and unreliable, both within the camp and prior to being displaced in Myanmar. This was felt to be particularly salient for single girls. “There is no safety for girls [in the camp]. Lots of gang people are there. We are afraid of them harassing young girls.” -IDI29, female, unmarried, age 21 In the case of protection from sexual harassment, getting married was seen as an answer to safety concerns associated with falling victim to eve-teasing iii and other forms of sexual harassment commonly faced by young women in camp settings. Married girls were, or were at least perceived as being, more protected from such types of harassment as compared to unmarried girls. Moreover, there were fears that verbal harassment could escalate to physical sexual assault, further exacerbating the need to use marriage as a protective strategy. Notably, all transcripts which referenced safety were from female participants who were either married before the age of 18 or were unmarried themselves. “My parents were concerned about my security as I was young and pretty. They feared something might happen to me. Getting me married was a way to ensure my safety. But I don’t know how. Anything bad could have happened even if I was with my husband. But that gave them peace, so I have no comments on that.” -IDI10, female, married at 16, age 22 The threat of sexual harassment and assault was seen as one of, if not the greatest, threat to females’ safety in the camp amongst community members, eclipsing other related concerns such as maternal mortality or morbidity. “Interviewer: Why did you marry her [your sister] off so early? Participant: We lived in a small place with men all around us. So, there was a security problem. Thus, we decided to marry her off because we were scared for her safety and security… We didn’t think about death at childbirth because it was a matter [for a] later time, while the fear of safety and security was present. So, we married her off.” -IDI44, male, married at 18, age 24 Some protection concerns extended to boys as well. However, these concerns more often had to do with protecting boys from the temptation to engage in activities – such as harassing women or engaging in premarital sexual relationships – that would bring dishonor and stigma to boys and their families, rather than protection from physical or sexual harm directed at them. “Boys can be free from doing sins if they marry earlier. They wouldn’t be involved in any love relationship or get physical with any girl if they are married off at an early age. That’s the practice here.” -IDI35, male, married at age 14, age 20 “At least by getting married, they [boys] have some responsibilities of their own and to stick to their family members and their wives. This is just a way to… you know, keep the men attached to the family.” -IDI14, male, married at age 22, age 23 In some cases, fear of single boys being more likely to engage in gang activity and/or in drug use within camp was also mentioned as an impetus for child marriage. “My parents thought that since all my elder sisters had died, they were afraid about me. They thought, what would they do if something bad happened to me or if I became friends with the bad guys and started taking drugs or do evil things? So, they wanted me to get married and be family oriented. That's why I got married.” – IDI15, male, married at 17, age 19 In FDMN communities, pre-marital relationships are often considered immoral, sinful, and dishonorable and can carry heavy social stigma, for both the female or male teens engaging in them and their families. Participants frequently described how the close-quarters conditions of the camps put an increasing number of adolescents in close proximity with each other. This was believed to increase the likelihood that unmarried adolescents would start “illicit” romances or affairs with each other. These “affairs” were often described as a driver of child marriage, as parents chose to marry their adolescent early to prevent adolescents from continuing to engage in pre-marital relationships that could bring shame onto themselves and their families. “If marriages are arranged by parents, they choose girls who are [age] 18 for their sons. When marriages take place out of love and without interference from parents, girls get married between 10-15… a man is usually 21 years old when the parents arrange marriage. In the case of marrying out of love, boys are between 15-18 years old when they get married." -FGD9, married female age 15-24 Socioeconomic Protection. Marriage of girls specifically was also seen as an answer to socioeconomic instability within the household, both on the part of the girl’s household of origin and for the new husband’s household. Female participants occasionally described their parents deciding to “marry them off” to relieve the family of either the physical constrains of her family’s tight living quarters and/or to ensure her financial future. This included security in the case of her parents’ death, which would otherwise strip her of continued financial support from them. “Many people marry girls off, thinking about who will take care of the girl when the parents are old or die. Many people marry girls off after they are of the right age. Some are poor; others are married early because they do not have a father or a mother.” -IDI32, female, married at age 18, age 20 “We were living in a small house which could be a reason. We had difficulties living in such a small place… Interviewer: After your brother’s marriage, the house became more congested? Participant: Yes. Due to this reason, my parents decided to marry me off.” -IDI33, female, married at 17, age 18 Male participants often explained that they or their parents sought out a wife because their household needed someone to do the type of domestic labor traditionally ascribed to women. This was typically due to recent changes in the male’s household composition (e.g. the male’s sisters were recently “married off” and were no longer able to do these household chores and/or there was an absence of another elder female family member – most often the mother – who would otherwise have been able to fulfill this role, either due to illness or death). “Our house had no heart because my sisters got married, and no one could see our sick mother. Because of that, my brother got married…he was married early so his wife could take care of our mother and do the work that our mother could not do.”-IDI26, unmarried, age 22 “Yes, [I got married] because my mother died. I have two younger siblings. So, my father said that they will become helpless.” -IDI4, male, married at age 16, age 21 “There is no one else in my family except me. I have to serve my parents. I have to work. I must serve them and earn money. I got married so that I would have someone at home to look after my parents when I’m out working” -IDI20, male, married at age 18, age 18, no children Dowries (and the inability to afford them) also came up in a highly gendered way, with the majority of transcripts mentioning dowries being from unmarried female participants. Of the participants who discussed dowries, around three-fourths reported there was a dowry exchange for their female family members, whereas around one-fourth reported no dowry exchange. Dowry was frequently mentioned as a barrier to marriage for girls (i.e. the bride’s family being unable to provide a dowry, despite their desire for their daughter to marry). Participants occasionally mentioned families resorting to loans to pay their daughter’s dowry, or sending their daughters to Malaysia so that they could get married without having to pay dowry. “There are lots of girls who belong to poor families that can't get married [due to the dowry system]. They marry their girls off when they save some money. If they can't do that, they marry them off by taking loans…if they can't get them married here [in Bangladesh], they send them off to foreign countries by marrying them off with men who are much older than them…her parents forcibly marry her off even if she's not agreed.” -IDI29, female, unmarried, age 21 A few participants mentioned that dowry isn’t always expected because families commonly deal with financial hardship within camp, but this seemed to be more an exception rather than a rule. “Those who have jobs get proper salary every month they give more dowry than others. They give mobile phones and money. Those who are poor don't have money to give dowry. Also, there are some people who understand [so] they don't demand dowry.” -IDI28, female, married at age 16, age 19 Only two participants explicitly mentioned dowry as a clear motivator in their decision to get married – one a married male whose family needed additional finances, and one an unmarried girl who was accusing boys’ families of being greedier about dowries than they were in Myanmar due to their own scarce resources in camp. “[My bride] was only 13 years old. But I had nothing else that I could do [to support my family’s financial needs]. I had to marry for the sake of my family members.” -IDI35, male, married at age 14, age 20 Lack of Education and Livelihood Opportunities. Many male participants expressed great frustration at the lack of educational and career opportunities in camp, citing rules which prevent FDMNs from engaging in formal employment opportunities and a lack of formal schooling options within camp. This was often described as a reason parents encouraged their adolescent children to get married, as adolescents had few other options for occupying their time and contributing to the community. “My family wanted [my brother to marry]. His study has also stopped and there's not much to do here. So, my parents thought it would be better if he got married and started his own family.” – IDI1, Male, unmarried, age 20 This lack of education and livelihood opportunities also occasionally tied into the aforementioned protection issues for boys specifically, as “having nothing to do” was seen as a risk factor for engaging in sexual harassment or gang activity. “There is no activity here in the camp. So, boys get married at the age of 17/18. The reason for doing this is that they cannot study much here. Cannot go to college after class 10 due to rules and a lack of opportunities. So, they do not study or do business or work. Then, while not doing anything like that, they get involved in bad deeds. That is why they get married.” -IDI14, male, married at age 22, age 23 Yet even the few male participants that described being able to find income-generating opportunities despite the restrictions and access issues were often not able to overcome other drivers for child marriage. For example, their having work left a gap in caretaking and household responsibilities, thus tying back into seeking a wife to fulfill those roles in their absence. “In 2017, we came to Bangladesh from Myanmar. We [young boys] had nothing to do [upon arriving]… I wanted to study, but I couldn’t. My father told me to work in his shop… [but] someone had to take care of the household chores, take care of my parents, maintain the house, and do everything. My parents cannot do that anymore. I am in the shop the whole day. What other option did I have [but to find a wife]?” -IDI3, male, married at 18, age 19 Very few female participants expressed a similar frustration with the lack of educational and livelihood opportunities. However, participants occasionally mentioned that, because girls are culturally expected to stop going to school once they reach menarche, they are then forced to stay within the house for the majority of their adolescents, which can be ‘concerning’ for their families. “There is another reason for marrying off girls before 18. A girl becomes a maiden [reaches menarche] by the age of 15. So, from 12 to 15 years old, we [would already] have to keep her at home for 3 years after becoming a maiden, let alone [until] 18 years old. They stay at home for 3 years [minimum]. Within this time, if she doesn't get a chance to have an education, if she doesn't have any other work, she sits idly at home. A maiden girl sitting at home is a matter of concern for parents… [Girls often] have to stay [within the home for] 6 years, which is very long… That is why we marry off our daughters early.” -FGD14, married male age 15-24 Limited Enforcement of Minimum Age Requirement for Marriage. Many participants felt that age requirements for marriage were easy to circumvent in the camp setting. For example, several female participants who were married prior to age 18 admitted that they (and/or their family) purposefully lied about their age, forged documents, and/or did not notify the CIC of their marriage, to avoid penalization or repercussions. “I was 13 when I got married… [my mother and in-laws] arranged a fake birth certificate for my marriage and according to this certificate, I am 19.” -IDI47, female, married at 13, age 15 “Some people are still getting married at a young age by showing false documents. They [also] often get married, but don't register it to CIC until they are of age.” -IDI48, female, married at 17, age 18 However, other participants felt that the CIC was able to adequately restrict child marriage within camp. Most often these were male participants. “No, people can't get married whenever they want to, as CIC made restrictions on early marriage. They forbid those girls who are below 18 and the boys who are below 21 to get married. And we need their permission to get married.” – IDI1, male, unmarried, age 20 Impact of Conflict & Displacement on Marriage Drivers “Eloping out of love is one reason for [child] marriage. Some parents can’t afford the expenses of their daughters and decide to marry them off [early to relieve their financial condition]. The death of the parents is another reason for early marriage… [but] if [the girl’s] parents can’t afford a dowry, they can’t marry their daughters off.” -FGD9, married female age 15-24 On Protection-Related Drivers. Many participants felt that, while some protection-related issues were present prior to displacement, protection concerns have significantly increased within the community due to the camp setting post-displacement. For girls, the use of marriage as a form of protection in the face of uncertain and unsafe conditions seemed to have also been present in the FDMN community prior to their displacement to Bangladesh; some participants described that a lack of safety in their home villages similarly drove decision-making around child marriage. However, in this context, the threat of sexual violence was described to be less-so from other community members, and more a threat from those who were assaulting their villages. “When they burnt our villages and godowns and everything. Amidst the massacre, I was married off. The people got scared. They were killing everyone. Young girls were getting tortured. My parents also got scared about our security. I was young and beautiful, you know? There was more risk of being tortured.” -IDI9, female, married at 12, age 18 “Interviewer: So, after the violence in your village, your parents decided to get you married? Participant: Yes, that’s why they got me married. It was not very secured to have an unmarried girl at home in that tense situation. Everyone was doing the same.” -IDI9, female, married at 12, age 18 By contrast, participants frequently described how the camp setting put adolescents in closer-proximity with each other more often than they ever experienced previously in Myanmar, increasing the threat of protection-related concerns from within their own community. Participants often explicitly tied the close-quarters nature of the camp setting to increased levels of eve-teasing and sexual harassment on the part of boys, increased safety concerns for girls when spending time outside of their home, and a notable increase in the likelihood that adolescents entered into the types of pre-marital relationships that drove their parents to want to marry them as quickly as possible to each other, regardless of their age, for fear that their relationship would bring shame unto their families via inappropriate social contact, pre-marital sex, or an unintended pregnancy. On Socioeconomic Drivers. Many participants also described the effect that conflict and displacement had on socioeconomic drivers, and the results were also highly gendered. For girls, participants most often described that being displaced had increasingly strained their family’s financial and living situations, effectively pushing unmarried adolescent girls out of their household of origin to alleviate those strains. Amongst both genders, participants often implied that the conflict and displacement had put their family members at increased risk of becoming sick or passing away due to poor migratory conditions and living conditions within camp. For boys, this translated to an increased likelihood that they would need to find a wife to “replace” female family member who were no longer able to take care of other ill family members and/or perform regular household chores. For girls, this translated to increased fear that the household of origin would not be able to financially provide for them, further increasing the likelihood that her family would be incentivized marry her off. “When I was in Burma, my parents didn't have to be taken care of, I didn't have to support my parents because we had more relatives and more property… I would not have to support my family [in Myanmar], I could have stayed with my studies. I could have reached my goal. After coming here, my parents became ill, I was forced to get married to help my parents… I have to feed them with my income. If I take care of my parents, we don't have food to eat. That's why I had to get married. My wife takes care of my parents, and I work and earn a living.” -IDI20, male, married at 18, age 18 “Interviewer: If you were in Myanmar, you [said you] wouldn’t have gotten married, but in Bangladesh you did. Why wouldn’t you have gotten married there? Respondent: Here, I can’t go anywhere. We earned money there, but here we can’t earn enough money. We had so many jobs available in Myanmar, but we don’t have such options in Bangladesh... Also, my parents became sick after coming here. I think the whole process of leaving our village was a lot to take for both of them. They have never been the same after that. I would have never married at this age if it hadn't been for them. I could have enjoyed my life the way I wanted to in Myanmar. -IDI3, male, married at 18, age 19 “Here [in Bangladesh] we don’t have money. We are living by managing to take money or food from here and there. Yes, people marry off their daughters [at early ages] due to a shortage of money.” -FGD4, unmarried female age 15-24 Participants generally agreed that expectations around dowry had increased in Bangladesh as compared to Myanmar, despite more families having comparatively less capital in the camps. However, there was disagreement regarding whether this was universally true or enforced, and the affect (if any) on rates of child marriage. In fact, there was some evidence that the increased dowry price may have prevented child marriage for girls who would’ve otherwise been married had their families been able to provide a sufficient dowry. “Interviewer: Was dowry common in Burma? Participant: Yes. But after coming here it has been increased. Like, in 2017/2018 it was not that high. Gradually the amount of dowry increases. It is a huge burden for us. Especially for the people who do not have a proper earning source. Interviewer: What is the reason for it? Participant: Some people do illegal jobs here. They can earn more. So they give a huge amount of dowry for their daughter’s or sister’s marriage. So people became greedy now. They want more and more. Not only money but also gold, phone, and furniture. For example, now people know that they can get many things from a dowry easily. So, it became a trend here. The more you can give the more your demand is for marriage. My father has died and my brother is married. We don’t have that much money to give and arrange all these things. This is the reason why my marriage could not take place.” -IDI19, female, unmarried, age 19 On Education and/or Livelihood Opportunities. Male participants drew clear distinctions between the availability of livelihood opportunities pre- vs. post-displacement, saying that the stark lack of livelihood opportunities has only been present since moving to Bangladesh. Participants also tied this back to boys being more at-risk for engaging in eve-teasing and other inappropriate behavior because they were not otherwise busy with school and/or work. “Participant: It would be good if there is a factory as there are so many jobless young boys. They tease the girls and sit idly here and there. It would be stopped if many of them could get to work… Interviewer: Was it like this also in Burma? Participant: there, they didn't get the chance to do these things as they were busy with their business and others. Here they are jobless, so they do all the wrongdoings.” – IDI1, male, unmarried, age 20 Many male participants described their educational and professional dreams prior to the conflict and displacement, and how they were forced to give up those dreams because of lack of access to education and restrictions on working as a refugee within camp. “I was very sad [to leave Myanmar]. I had to leave my own home, land, and life. I had to stop studying…[In Myanmar I would have studied] to the highest level I could. I wanted to be a doctor, but I had to let go of my dream after coming here.” – IDI1, male, unmarried, age 20 Participants who seemed most discontented by the lack of educational opportunities were those who had made progress in achieving their educational and professional goals in Myanmar. More often, these were relatively older participants who had migrated at a point where they were close to finishing their studies and were forced to stop before completion. These participants sometimes expressed that, because they were unable to finish their studies and were comparatively closer to a marriageable age than their younger peers, they “had to” get married earlier in Bangladesh than they would have in Myanmar. “If all goes well, a boy passed matriculation at the age of 16 in Burma. As I passed matriculation in 2016, I would have been able to study for another four to five years. I could study at university. I got admission at the university… If I had been in Burma, I would have continued my studies. That's why there's been a lot of difference. Not being able to read has caused a lot of damage to my community, to myself, and to my family. I can't support my family as much as I was supposed to. My mentality did not improve as I could not study… If I were in Burma, I would have studied…but after coming to Bangladesh in 2022, due to the society, due to the situation, I had to get married. It's been a big difference to me.” -IDI21, male, married at 23, age 24 “I wanted to study up to class 10 in Burma and get admitted to college. After getting higher education, it was my desire to open a big school and [then] run the family. I have been forced to come here, and I have to work, so there is no time to go to college here, no school, I have studied up to class 10 here. I couldn't reach my goal. I had to get married to serve my parents. I couldn't meet my goal because of all this.” -IDI20, male, married at 18, age 18 By contrast, girls were restricted from education during much of their adolescent years even in Myanmar prior to the conflict or displacement, due to cultural norms around girls exiting school once reaching menarche. “There was a custom in Myanmar among our people when we lived there. Girls weren’t allowed to attend school once they turned 12 or 13. These girls were thought to be too old to continue studying. I had to quit for the same reason…When girls go through puberty, it indicates the time to stop studying. The family members do not allow the girl to go to school. We can’t go against them… My parents forbid me to continue studying, and I felt I shouldn’t study anymore.” -IDI33, female, married at 17, age 18 On Enforcement of Minimum Age Requirements for Marriage. Participants often directly compared the restrictions around marriage prior to age 18 in Myanmar to those in Bangladesh, and described similarly variable levels of compliance. However, there was not clear consensus regarding whether participants perceived restrictions as being more, less, or similarly strict to those in Bangladesh. More participants felt that marriage restrictions in Bangladesh were looser or relatively nonexistent as compared to those in Myanmar, and subsequently felt this was increasing child marriage rates. Yet, others described a perceived tightening of marriageable age restrictions and their enforcement in camp due to stricter monitoring by the CIC. Participants from Camp 1W and Camp 4 more often described the CIC as being strict in this way. “In Burma, [girls] could not marry before the appropriate age… [or else she] would be jailed. I think some girls are married off at an earlier age [in Bangladesh] because there are no laws about it. No restrictions on it.” -IDI32, female, married at age 18, age 20 Current Childbearing Norms “Most [girls] have a baby quickly [after marriage, regardless of their age at marriage]… In this way, it is better to have a second child five years after having the first child… to keep the [mother’s] body healthy. [But soon] after getting married, the first baby has to come into the stomach… [because] if you have a child, affection is born in the mind of the husband… and he will no longer marry anyone outside [of the original marriage].”-FGD5 participant, married female age 15-24 Time to First Birth. Participants universally described the societal expectation of initiating childbearing shortly after marriage, and typically within the first year of marriage. The pursuit of having children within the first year of marriage was shared by both married women and men, further illustrating the strength of the norm around demonstrating fecundity immediately after marriage and thus the resistance to delaying first birth across both genders. “The year you get married, you have children. If you marry at the age of 18, you have a child at the age of 18, and if you marry at the age of 20, you have a child at the age of 20… you [always] have a child in the first year of marriage. This is the culture of our Rohingyas. [This is because] parents think that when [their married children] are older, they will not be able to raise their [own] children well. Grandparents want to see their grandchildren's faces." -FGD2, married male age 15-24 “My husband, in-laws, parents, and neighbors give me suggestions for conceiving. They say one should have a child as soon as possible after marriage. It's good for the couple to have a stronger bond.” -IDI48, female, married at 17, age 18, no children The only accepted exception to this norm was in certain cases where girls were married very young. However, child marriage did not universally exempt younger brides from fulfilling what was considered their wifely obligation/duty. “People who are [married] young should take birth control pills because at that age our body is not healthy enough to have a child. People call it a sin. But it's not the case. But people who want to do it do it anyway… I think [taking birth control] should be done because of concern for a mother's health and well-being.” -IDI43, female, married at 17, age 21, 1 child Fears of the consequences of delaying first birth included social stigma (ie. other community members judging and gossiping about couples for not having children earlier), not solidifying the bond between husband and wife, marital arguments, and girls specifically being accused of being infertile or “barren”. “There were neighboring women near the house, and they advised my wife to have a child as soon as possible. All of them said it’s best to have a child immediately after getting married. If we delay the process, there is a chance that we will never have a baby. You can say this is the culture here or the practice… So, I had to follow that too.” -IDI24, male, married at age 17, age 19, 1 child “When I wasn’t pregnant 1-2 years after the marriage, everyone started to talk bad things about me. That I cannot have a child, I am a “Baja” (infertile) woman and my husband should be remarried. My neighbors, relatives…everyone was bad mouthing me.” -IDI9, female, married at 12, age 18, 1 child “If we don't have children after we get married, we will then spend a long time taking birth control pills. That is seen negatively in our community and people pass many kinds of comments. Another thing is, if we don't have children after marriage, there arises any kind of conflict between husband and wife. So if we have a child, I will feel more affection towards my wife and I will be more responsible for my family. If, after we try to have a child, we can't get pregnant, then we will fight a lot. As [another participant] said earlier, we should have a child as soon as possible [after marriage]. There is no gain in being embarrassed. Husband and wife desire to have a child right?” -FGD1, married male age 15-24 Another perceived consequence of not having a child soon after marriage was the threat of a husband seeking a second wife (ie. choosing to enter into a polygamous marriage) with the rationale being that a second wife might be able to provide him with a child as an alternative. Female participants often described choosing to have a first child quickly after marriage as a tool to keep her husband invested in their relationship. “Some men actually marry again [seek another wife] if their [first] wives can’t conceive a child. It is common in this society.” -IDI33, female, married at 17, age 18, no children Despite this strong societal expectation to demonstrate fecundity immediately after marriage, several IDI participants did specifically mention wanting to (or wishing that they could) delay childbearing and not have children right after marriage; all of these were women, and all but one were married before age 18. There was also a number of participants, particularly those who participated in FGDs, who said that it would theoretically be ideal to wait until age 18-20+ to start having children, especially for women. Reasoning typically included to preserve the health of the mother and to ensure that the couple was “prepared” or “matured enough” to be parents themselves. However, this was often underpinned by discussions that demonstrated that societal expectations around shorter times to first birth almost always took precedence over personal preference. “I wanted to wait a few more years before having any babies. But I was bound to at that time.” -IDI9, female, married at 12, age 18, 1 child Fertility Rate, Birth Spacing, and Family Planning. By contrast, participants described there being significantly more leeway in decision-making around childbearing after the birth of their first child. After the birth of their first child, young couples were seemingly given more space to make their own decisions on desired number of children and preferences around birth spacing, without the same level of heavy societal pressure from community and other family members. “[My in-laws] don’t want us to take another baby right away. They know how much pain I had to endure during the birth of my first baby at such an early age. So, they told us to wait until our first child grows up.” -IDI8, female, married at 17, age 19, 1 child When asked, many participants explicitly stated wanting to wait somewhere between 3-6 years between their children. This desire was mostly motivated by considerations of the mother and living children’s health and was discussed by both male and female participants. Family planning was fairly openly discussed as a way to achieve desired birth spacing. Participants more often described family planning as being beneficial, particularly in promoting the health of mother and child. “My first child was born unplanned. To avoid another unwanted pregnancy, I am taking [birth control] pills. If I conceive another child, then none of my kids will get a better life. After my firstborn is all grown up, I will think of taking another child. If I take another child now, then there is a huge chance both of them will get sick. -IDI7, female, married at 19, age 20, 1 child Use of family planning seemed to be significantly less stigmatized after the birth of a first child than prior to first birth, though a few participants did mention religious stigma and family planning being considered a sin. “After marrying, I will have a child. After [my first child is born], if I think it's necessary, I will use family planning, but not before that.” -FGD1, married male age 15-24 Impact of Conflict and Displacement on Childbearing “ Interviewer: Are people having children at the same age here? Participant: Yes. But they could have had more in Burma; they are having less children here. There is no place to stay, there is no arrangement for education, and there is no food. In short, you can't feed, you can't teach, there's no income - that's why people are having fewer children.” -FGD13a, married female age 15-24 On Time to First Birth. When asked about the effect the conflict and/or displacement has had on childbearing, no participants discussed time to first birth, nor described there being any difference in the pressure to demonstrate fecundity soon after marriage in Bangladesh as compared to Myanmar. On Fertility Rate, Birth Spacing, and Family Planning. Almost all participants, however, agreed that couples were having far fewer children and engaging in family planning more in Bangladesh than they did in Myanmar. Many attributed this to an increase in access to health education and family planning methods, as compared to what was available in Myanmar. “In Myanmar, married couples may want to have 6 to 7 children. Here they want to have 2 to 3 children so that the children can be healthy.” -IDI47, female, married at 13, age 15, 1 child “In Burma, people used [family planning] less than in Bangladesh, the rate of using family planning methods has increased here. [In Myanmar] there was just 1 method [available], which was injections [Depo-Provera]. People didn’t know about other methods, or even if others existed. They also didn't consult the doctor about family planning methods. Here, couples discuss family planning and go to the hospital and [community health volunteers] come here [to our homes] frequently.” -FGD8, unmarried male age 15-24 Many of the participants cited one or more constraints to childbearing within the context of living in camps specifically, the most common being a lack of educational opportunities for children, followed by lack of space for children to live in and/or play, followed by shortage of money/income, and poor access to health services. These sentiments were strongly held and evenly shared by both male and female participants. Less commonly-discussed constraints were general instability due to the conflict and not wanting their child to grow up without a home country. “Here [in Bangladesh] we decide to have fewer children. We don’t have our own house here, and it is not certain how long we can stay here. We may have to go back [to Myanmar] if we are told to do so. Moving with lots of children is difficult. Due to these reasons, married couples have 2 to 3 children instead of 4 or 5 children. Men also don’t have any work here. They won’t be able to bear the expenses of many children. This is also a reason.” -FGD9, married female age 15-24 “We are living in a foreign country right now. We are refugees. We won’t be able to educate our children properly, as there are no provisions for education here. Besides, rearing many children will be difficult here. We may not get proper medical treatment… and look at our houses. We don’t have enough space to have many children. Where will they stay when they grow up?” -IDI33, female, married at 17, age 18, no children “If I have a child [like my parents want me to], the child will receive no birth certificate here [in Bangladesh] because we are refugees… If the children ask their parents where our country is, we can't show it. So, [displacement is] causing much damage to us.” -IDI20, male, married at 18, age 18, no children Only a few participants stated that they felt there had been no impact of conflict and displacement on the average number of children couples were having, of them, most stated that childbearing is up to “God’s Will” rather than personal decision-making or circumstance. [1] Participants often used “Burma” to refer to their home country, as the difference between using “Burma” vs “Myanmar” is more distinct in English. [2] “Eve teasing” refers to the act of males making unwanted sexual remarks or advances towards a female in a public space. DISCUSSION Our research demonstrates that conflict and displacement have amplified some previous drivers of child marriage and especially practical drivers, such as concerns of sexual violence and the socioeconomic incentives surrounding marriage. In other cases, conflict and displacement have introduced new drivers, such as concerns of increased illness and mortality among family members and severely limited education and livelihood opportunities (for boys specifically). However, conflict and displacement appeared to have no impact on the norms of girls getting married younger than boys, nor the pace of the transition from marriage into parenthood, though it appeared to strongly reduce the total number of children desired as a response to severe living conditions. We found consensus that the ‘ideal’ age of first marriage for girls was 18 exactly and was slightly older for boys, The consistent and explicit mention of age 18 exactly likely points to our participants receiving strong messaging from either the CIC, local NGOs, or both reinforcing that 18 is the minimum legal age of marriage. While our findings echo the findings of a previous study conducted by Islam et. al, (37) which also found a strong preference for 18 as the minimum ideal marriageable age, another study conducted by Melnikas et al. (38) just one year earlier had found a stronger preference for marrying prior to age 18 amongst community members. It is unclear if social desirability bias may partially explain our findings, or if participants have genuinely adopted the messaging surrounding “ideal” minimum age at marriage. Our qualitative findings mirror our quantitative findings – see: “Family formation among adolescent Rohingya refugees; Understanding trajectories into adolescent marriage and childbearing in Cox’s Bazaar Bangladesh” – which found a sharp increase in risk of marriage at age 18 exactly for girls. These combined findings may point to a strong trend within the community towards getting married at age 18 exactly (especially for girls), or potentially a tendency to report a marriage once the bride and/or groom have turned 18. However, both our qualitative and quantitative results also demonstrate that child marriage remains common and accepted within this community, particularly for girls, and that girls tend to marry younger than boys. This is likely at least partially due to the cultural stigma that is put on “older” brides that does not exist in the same way for boys, which has also been similarly demonstrated in previous research (37,38). Participants largely reported that conflict and displacement had led to an increase in child marriage within the community, and most married participants felt that they would’ve married later had they stayed in Myanmar and had not been affected by the conflict. Interestingly, perceptions of increasing child marriage rates are seemingly not reflected in our quantitative findings, which showed lower rates of child marriage amongst adolescents aged 15-19 than aged 20-24. One explanation for this discrepancy could be that recently-married adolescents who are younger than age 18 would be less likely to report their marriage in the survey, and thus our quantitative findings are only observing a decrease in reported rates of child marriage, not actual rates. Our qualitative research also asked about the change in child marriage due to conflict and displacement more generally, meaning that qualitative participants were likely comparing current rates of child marriage to those that occurred before the latest wave of violence in 2017, while quantitative findings compared between age cohorts, but not by specific years. It could be that during the onset of conflict in 2017, child marriage rates increased from what they were pre-conflict, but decreased somewhat once families were settled in Bangladesh – though never declining to the levels that existed prior to displacement. This would be supported by our qualitative results, as several participants mentioned that more girls were married at the onset of the latest wave of conflict because of the immediate threat of violence and sharp rise in overall uncertainty. Overall, our qualitative findings related to child marriage drivers indicate that, while some drivers within the Rohingya community have either continued or have been exacerbated across pre- and post-displacement settings (e.g. security concerns) others (particularly religious considerations) may have been at least partially replaced or obscured by practical considerations, given the camp context. In other words, early marriage appears to largely serve as a tool to improve uncertain and vulnerable situations for Rohingya adolescents and their families, rather than an ideal or spiritually superior situation by which to form a family. The rationales by which this tool was employed, that is, the motivations why a girl or boy would be married early, were highly gendered, however. For girls, concerns of sexual, physical, and/or social harm were paramount. This was particularly salient in the camp setting, where conditions are generally considered unsafe, and especially so for unmarried adolescent girls. This is consistent with other literature (38,52) that highlights the role of marriage as a necessary tool for protection from physical and sexual violence amongst the Rohingya – both pre- and post-displacement. One more unique finding from our research was that marriage was also often viewed as a tool to protect boys from perpetrating immoral acts (eg. eve teasing) and/or violence themselves. Thus, child marriage was more a tool that dissuaded “bad” behavior, that would otherwise dishonor themselves and their families, and instead allowed them to secure positive and respected status as a husband within their community. For both genders, marriage was a way to rectify premarital relationships forming against parental will. Similar themes around using marriage as a tool to preserve family honor and premarital purity were similarly described by several other studies conducted with Rohingya adolescents (37,38,53), underpinning the strength and consistency of this driver. This was the single strongest moral/religious consideration for child marriage discussed by our participants, though it more described child marriage as a method to avoid or correct immoral actions on the part of the adolescents/young adults (e.g. eve-teasing, participating in a pre-marital relationships), rather than argued the inherent morality or benefits of marrying early. iv This illustrates a potentially key window of opportunity for practioners to develop and encourage alternative outlets for adolescent boys, (perhaps skills-building or community groups) as a way to avoid “immoral” activities by engaging them in societally-respected activities instead of marriage. Marriage also served as a major socioeconomic tool. In the otherwise economically limited camp context, girls served in some ways as a socioeconomic currency, benefitting both the household of origin, by reducing consumption and increasing space, and the husband’s home, by providing dowry and conducting gendered household labor. This often made marriage mutually beneficial to both families from a financial standpoint. Using marriage as a means to alleviate family burden has been similarly found in previous research amongst Rohingya adolescents (38). Patriarchal gender norms regarding gendered labor within the household also play a large factor in this marriage economy. Females are expected to take on traditional household and caretaking duties, whereas men are expected to act as the traditional breadwinners. As a result, boys and their families often sought brides to provide household labor when other females (especially the boys’ mother or elder sisters) were reportedly unable to provide this household service due to death or illness. This was seemingly true even when boys were otherwise unoccupied due to lack of educational and or livelihood opportunities themselves. Thus, many male participants expressed a need to get married to help their sick family. As participants felt that the conflict and their displacement experience put their older family members at increased risk for illness and death, this mechanism was explicitly tied to the conflict and displacement and was a common explanation for why participants felt they married earlier in Bangladesh than they would have in Myanmar. Our findings regarding dowry are consistent with current literature, which describes generally lower expectations around dowry amounts, but that financial limitations still challenge the affordability of marriage for some girls’ families. (38) Rohingya are prohibited by the Bangladeshi government from working due to their FDMN status, which makes livelihood and income-generating opportunities very rare within camp. Moreover, there is no formal system of schooling within the camp, and all educational opportunities are provided informally via NGOs or private tutors. Without these typical outlets, adolescents are left with few ways to demonstrate independence and to contribute to their community. Thus, in addition to the protection-related and financial incentives that marriage can provide, child marriage may also act as one of the only remaining markers or milestones to signify reaching adulthood for FDMN adolescents. Restoring the social and economic opportunities that are typically available to adolescents in non-displaced settings (i.e. employment and education) would provide the best alternatives to marriage for adolescents (and particularly males), who are otherwise at home with little to do and little other way of establishing their transition into adulthood. Additionally, in our focus group discussions, participants often mentioned that they appreciated the opportunity to share with their peers and learn more about these topics. Though outside the scope of this paper, qualitative data on premarital knowledge did indicate that adolescents didn’t have many opportunities or spaces to discuss themes around child marriage and early childbearing prior to marriage. Thus, the creation of adolescent groups may be a useful compliment to the provision of educational and livelihood opportunities to more directly discuss and educate adolescents on topics of marriage and childbearing. Because of existing gender norms and taboos about adolescents not engaging in pre-marital relationships, separating these groups by gender would likely be critical for community acceptance. However, this would also give facilitators the unique chance to discuss the gender-specific ways that the conflict and displacement has affected both girls’ and boys’ experience of child marriage and early childbearing to prevent future early marriages. Melnikas et al. and Islam et al. both identified religion as a notable factor underpinning early marriage and that the teachings of Islam directly mandate earlier marriage (particularly for girls at the onset of menarche) within the Rohingya community (37,38). Interestingly, the same could not be said for this study. While our interview guides did not specifically inquire about the role of religion, open-ended questions about drivers of early marriage within the Rohingya community rarely produced mention of religion, Islam, or related teachings. Moreover, as part of a participatory Venn diagraming activity, FGD participants were asked to categorize people and events into categories as having the “most influence”, “a lot of influence” or only “some” influence regarding decision-making around marriage age and timing within their community. FGD participants overwhelmingly put religious figures such as Imams and Majhees in the “some influence” category, and a couple focus groups did not mention religious leaders at all. While our findings do not necessarily contradict previous findings around religion, they do perhaps point to changing socioreligious norms, and/or more practical child marriage drivers becoming relatively more salient amongst the Rohingya community after experiencing more prolonged displacement within the camp setting. We found less evidence of ways in which displacement affected transitions into childbearing upon marriage. There was a strong cultural custom for near-immediate childbearing after marriage, regardless of the age of the spouses. The desire for immediate demonstration of fecundity after marriage was so strong that several participants communicated that, should a wife fail to conceive within a year or two of marriage, it was not uncommon for her husband to threaten to and/or enter into a second (polygamous) marriage to find a wife who increase his chances of having a child. This illustrates the pressure that young brides face to conceive early, in order to secure her marital relationship and avoid social stigma, which is reflected in qualitative data from numerous non-humanitarian studies (7,14) as well as one previous study conducted with Rohingya adolescents specifically (37). Social pressures to conceive thus seem to have been present prior to the conflict, indicating that this norm was largely unaffected by the displacement experience. This finding was reinforced by our quantitative findings, which demonstrated that there was no difference in time to childbirth after marriage between age cohorts or by age at marriage. Other norms around fertility, and particularly those around subsequent childbearing, however, were strongly affected by displacement. Numerous respondents identified challenges of raising families within the constrained environments of camps and chose to practice family planning to better provide for the children they already have. Fertility norms thus seem to be affecting overall desires for number and timing of children after the first child is born and family connections have been cemented. Thus, continued programming about birth spacing, particularly targeted at younger adolescents, could serve as an entry point to discuss family planning. Adolescent sexual and reproductive health programs that promote delaying first births, however, are unlikely to be successful without broader community engagement to address the pervasive norms surrounding the importance of demonstrating fecundity immediately upon marriage. Our study should be considered in light of several limitations. First, while we had hoped to exclusively recruit Rohingya data collectors for both male and female participants, only the male data collectors were Rohingya, and female data collectors were part of the host community. This was due to high levels of competition amongst IGOs and NGOs within the camps for female Rohingya volunteers, and limited availability. Despite our including topics such as cultural sensitivity and minimizing bias as part of the data collectors’ training, it is possible that longstanding tension between Rohingya and host communities (33) limited the level of openness our female participants felt with their interviewers, potentially affecting the correctness and/or depth of their responses. Additionally, stigma around movement for young, and particularly unmarried girls/adolescents limited the amount of privacy that interviewers had when discussing these sensitive topics with adolescents in otherwise quite cramped living conditions. It is possible that adolescents answered the questions differently out of fear that another family member might hear their answers and disapprove of them. Despite these limitations, however, our study has many strengths. We recruited a diverse response pool, composed of both married and unmarried males and females. Previous research in Cox’s Bazaar was limited to married females (37), and thus lacked a comparative perspective, both in terms of marriage or gender. Very few studies have included males in studies of child marriage, despite their own risks for marriage and the influence they have on female partners. Additionally, we partnered with an established organization, that was already well-respected and trusted within the community. CONCLUSION AND RECOMMENDATIONS Conflict and displacement were found to have a varied effect on family formation among Rohingya adolescents, particularly across genders. Additionally, the camp context both exacerbated preexisting drivers of child marriage, as well as created new drivers. Most child marriage drivers discussed by our participants were practical considerations, rather than a deep-set belief in the moral or religious imperative to marry early. This is somewhat of a departure from the emphasis that previous literature has placed on the cultural norms underpinning child marriage, particularly for girls. Early childbearing seemed to be much less affected by conflict and displacement, but fertility rates have seemingly significantly reduced due to resource constraints within camp. Efforts to improve adolescent sexual and reproductive health should be concentrated on restoring the educational and livelihood opportunities that both female and male adolescents have lost due to conflict, displacement, and living in a camp setting. The feeling of having no other options, pushes adolescents, and especially males and their families, towards pursuing child marriage and subsequent early childbearing. The Bangladeshi government must ease restrictions on availability of education and income-generating opportunities for FDMNs, as both would provide adolescents and their families with alternative options that would allow them to transition into adulthood and to contribute to their community outside of child marriage. Additionally, our participants, both married and unmarried, expressed a desire to have spaces like our focus group discussions where they can discuss these topics. Current programs geared towards child marriage and early childbearing are primarily, if not exclusively, focused on prevention – which leaves the population of already-married adolescents very few resources and outlets for support regarding their health and wellness within the marriage. Creating spaces for adolescents to gather may also provide an opportunity to discuss marriage and childbearing, generally considered “taboo” prior to marriage. These venues would also be opportunities to continue providing education around family planning and healthy birth spacing. Practitioners must work with the community leaders, like Majhees or the CIC, who regularly interact with recently-married adolescents to encourage participation in health workshops early on in marriage, when couples are beginning to establish their families. Addressing many of the restrictive gender norms that promote child marriage and childbearing, such as the need for females to conduct gendered housework and to prove fecundity upon marriage, require broader community engagement. Parents and community leaders must also be engaged in order to identify and challenge some of the most pervasive gender norms. This may be particularly important when addressing norms around early childbearing, which appear to be particularly persistent and little affected by conflict. Abbreviations CIC Camp-in-Charge CPI Community Partners International BRAC-JPG BRAC James P Grant School of Public Health FDMN Forcibly-Displaced Myanmar Nationals FGD Focus Group Discussions IDI In-depth Interviews IGO Intergovernmental Organization KII Key Informant Interviews NGO Non-governmental Organizations Declarations Human ethics and consent to participate. Ethical approval was provided by both The Johns Hopkins Bloomberg School of Public Health Institutional Review Board (FWA00000287) and BRAC James P Grant School of Public Health, BRAC University’s review board (IRB protocol no.: IRB-25 June’22-022). Due to widespread illiteracy and as Rohingya is not a written language, all participants provided verbal consent to participate. Consent for publication. Not applicable. Availability of data and materials. The qualitative datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Competing interests. The authors declare that they have no competing interests. Funding. Elrha R2HC (Research for Health in Humanitarian Crises) provided the funding for this study. The R2HC program is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome Trust, and the Department of Health and Social Care (DHSC) through the National Institute for Health Research (NIHR). Authors' contributions. KM contributed to the study design, designed study materials, supported data collection, analyzed the data, and wrote the manuscript. Tahia H contributed to study design, organized and conducted data collection, supported data analysis, and edited the manuscript. AC was a significant contributor to drafting and editing the Background section. KL supported data analysis and edited the manuscript. MB supported data analysis and edited the manuscript. Tanvir H contributed to study design, supported data collection and data analysis, and edited the manuscript. SE contributed to the study design, designed study materials, supported data collection, analyzed the quantitative data, and edited the manuscript. WCR designed the study, supported data collection and data analysis, and coordinated submission of IRB applications. LAZ designed the study and study materials, supported data collection and data analysis, coordinated submission of IRB applications, and was a major contributor to manuscript drafting and editing. All authors read and approved the final manuscript. Acknowledgements. The authors would like to first thank the Rohingya participants and communities within Cox’s Bazar who generously shared their time and experiences, thus making this study possible. The authors would also like to thank the members of the community advisory board, whose expertise allowed for more culturally sensitive and relevant interview guides and study implementation. The authors would also like to thank the many data collectors who carefully recruited, consented, interviewed the study participants. Finally, the authors would also like to thank CPI for their acting as a community liaison and providing space for trainings and data collection activities. Clinical trial number: Not applicable References Hassfurter K. Child Protection from Violence, Exploitation and Abuse [Internet]. UNICEF; 2011 Mar [cited 2024 May 9]. Available from: https://data.unicef.org/resources/child-protection-violence-exploitation-abuse/ United Nations. Universal Declaration of Human Rights [Internet]. United Nations; Dec 10, 1948. Available from: https://www.un.org/en/about-us/universal-declaration-of-human-rights UNICEF. Convention on the Rights of the Child [Internet]. 1989. Available from: https://www.unicef.org/child-rights-convention Arthur M, Earle A, Raub A, Vincent I, Atabay E, Latz I, et al. Child Marriage Laws around the World: Minimum Marriage Age, Legal Exceptions, and Gender Disparities. Journal of Women, Politics & Policy. 2018 Jan 2;39(1):51–74. UNICEF. UNICEF DATA. 2023 [cited 2024 May 9]. Child marriage. Available from: https://data.unicef.org/topic/child-protection/child-marriage/ Raj A. When the mother is a child: the impact of child marriage on the health and human rights of girls. Arch Dis Child. 2010 Nov;95(11):931–5. Miller FA, Dulal S, Rai A, Gram L, Harris-Fry H, Saville NM. “Can’t live willingly”: A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia. PLOS Global Public Health. 2023 Oct 23;3(10):e0002279. Erulkar A. Adolescence lost: the realities of child marriage. J Adolesc Health. 2013 May;52(5):513–4. Billah MA, Khan MdMA, Hanifi SMA, Islam MM, Khan MdN. Spatial pattern and influential factors for early marriage: evidence from Bangladesh Demographic Health Survey 2017-18 data. BMC Women’s Health. 2023 Jun 20;23(1):320. Misunas C, Gastón CM, Cappa C. Child marriage among boys in high-prevalence countries: an analysis of sexual and reproductive health outcomes. BMC International Health and Human Rights. 2019 Aug 16;19(1):25. Lee-Rife S, Malhotra A, Warner A, Glinski AM. What works to prevent child marriage: a review of the evidence. Stud Fam Plann. 2012 Dec;43(4):287–303. UNFPA. Marrying too Young [Internet]. UNFPA; 2012 Jan [cited 2024 May 9]. Available from: https://www.unfpa.org/publications/marrying-too-young Ibarra-Nava I, Choudhry V, Agardh A. Desire to delay the first childbirth among young, married women in India: a cross-sectional study based on national survey data. BMC Public Health. 2020 Mar 18;20(1):350. Scott S, Nguyen PH, Neupane S, Pramanik P, Nanda P, Bhutta ZA, et al. Early marriage and early childbearing in South Asia: trends, inequalities, and drivers from 2005 to 2018. Ann N Y Acad Sci. 2021 May;1491(1):60–73. Marphatia AA, Ambale GS, Reid AM. Women’s Marriage Age Matters for Public Health: A Review of the Broader Health and Social Implications in South Asia. Front Public Health. 2017;5:269. Fan S, Koski A. The health consequences of child marriage: a systematic review of the evidence. BMC Public Health. 2022 Feb 14;22(1):309. Psaki SR, Melnikas AJ, Haque E, Saul G, Misunas C, Patel SK, et al. What Are the Drivers of Child Marriage? A Conceptual Framework to Guide Policies and Programs. J Adolesc Health. 2021 Dec;69(6S):S13–22. Krafft C, Arango DJ, Rubin AH, Kelly J. Conflict and Girl Child Marriage: Global Evidence [Internet]. The World Bank; 2022 [cited 2024 May 24]. (Policy Research Working Papers). Available from: http://elibrary.worldbank.org/doi/book/10.1596/1813-9450-10135 Hunersen K, Attal B, Jeffery A, Metzler J, Alkibsi T, Elnakib S, et al. Child Marriage in Yemen: A Mixed Methods Study in Ongoing Conflict and Displacement. Journal of Refugee Studies. 2021 Dec 1;34(4):4551–71. UNFPA, UNICEF. Addressing Child Marriage in Humanitarian Settings: Technical Guide for Staff and Partners of the UNFPA–UNICEF Global Programme to End Child Marriage [Internet]. New York, NY; [cited 2024 May 24]. Available from: https://www.unfpa.org/resources/addressing-child-marriage-humanitarian-settings-technical-guide-staff-and-partners-unfpa Elnakib S, Hussein SA, Hafez S, Elsallab M, Hunersen K, Metzler J, et al. Drivers and consequences of child marriage in a context of protracted displacement: a qualitative study among Syrian refugees in Egypt. BMC Public Health. 2021 Apr 7;21(1):674. Hutchinson A, Waterhouse P, March-McDonald J, Neal S, Ingham R. Understanding Early Marriage and Transactional Sex In the Context of Armed Conflict: Protection at a Price. Int Perspect Sex Reprod Health. 2016 Mar 1;42(1):45–9. Tzemach Lemmon G. Fragile States, Fragile Lives: Child Marriage Amid Disaster and Conflict [Internet]. Council on Foreign Relations. 2014 [cited 2024 May 9]. Available from: https://www.cfr.org/blog/fragile-states-fragile-lives-child-marriage-amid-disaster-and-conflict Knox SE. How they see it: young women’s views on early marriage in a post-conflict setting. Reproductive Health Matters. 2017 Oct 27;25(sup1):96–106. Elnakib S, Paina L, Attal B, Akter R, Khoury G, Karim L, et al. Incidence of child marriage among refugees and internally displaced persons in the Middle East and South Asia: evidence from six cross-sectional surveys. BMJ Open. 2023 Jun 15;13(6):e070056. Neal S, Stone N, Ingham R. The impact of armed conflict on adolescent transitions: a systematic review of quantitative research on age of sexual debut, first marriage and first birth in young women under the age of 20 years. BMC Public Health. 2016 Mar 4;16(1):225. Samandari G, Sarker BK, Grant C, Huq NL, Talukder A, Mahfuz SN, et al. Understanding individual, family and community perspectives on delaying early birth among adolescent girls: findings from a formative evaluation in rural Bangladesh. BMC Women’s Health. 2020 Aug 10;20(1):169. Thiede BC, Hancock M, Kodouda A, Piazza J. Exposure to Armed Conflict and Fertility in Sub-Saharan Africa. Demography. 2020 Oct 16;57(6):2113–41. Castro Torres AF, Urdinola BP. Armed Conflict and Fertility in Colombia, 2000–2010. Popul Res Policy Rev. 2019 Apr 1;38(2):173–213. Woldemicael G. Recent fertility decline in Eritrea: Is it a conflict-led transition? Demographic Research. 2008;18:27–58. Mourtada R, Melnikas AJ. Crisis upon crisis: a qualitative study exploring the joint effect of the political, economic, and pandemic challenges in Lebanon on Syrian refugee women’s fertility preferences and behaviour. Confl Health. 2022 Jun 15;16(1):35. Hawkey AJ, Ussher JM, Perz J. “If You Don’t Have a Baby, You Can’t Be in Our Culture”: Migrant and Refugee Women’s Experiences and Constructions of Fertility and Fertility Control. Women’s Reproductive Health. 2018 Apr 3;5(2):75–98. UNHCR. Bangladesh: Analysis of Gaps in the Protection of Rohingya Refugees [Internet]. 2007 May [cited 2024 May 9]. Available from: https://www.unhcr.org/us/media/bangladesh-analysis-gaps-protection-rohingya-refugees-may-2007 UNFPA. Cox’s Bazar: A displaced people longing for a sense of home [Internet]. [cited 2024 May 9]. Available from: https://www.unfpa.org/coxs-bazar-bangladesh Mahmood SS, Wroe E, Fuller A, Leaning J. The Rohingya people of Myanmar: health, human rights, and identity. Lancet. 2017 May 6;389(10081):1841–50. UNFPA Asia Pacific Regional Office, UNICEF Regional Office for South Asia. Child Marriage in Humanitarian Settings in South Asia [Internet]. 2020 Oct [cited 2024 May 9]. Available from: https://asiapacific.unfpa.org/en/publications/child-marriage-humanitarian-settings-south-asia Islam MM, Khan MN, Rahman MM. Factors affecting child marriage and contraceptive use among Rohingya girls in refugee camps. Lancet Reg Health West Pac. 2021 Jul;12:100175. Melnikas AJ, Ainul S, Ehsan I, Haque E, Amin S. Child marriage practices among the Rohingya in Bangladesh. Conflict and Health. 2020 May 25;14(1):28. Plan International. Plan International. [cited 2024 May 9]. Child marriage in Bangladesh. Available from: https://plan-international.org/publications/child-marriage-in-bangladesh/ Akter S, Williams C, Talukder A, Islam MN, Escallon JV, Sultana T, et al. Harmful practices prevail despite legal knowledge: a mixed-method study on the paradox of child marriage in Bangladesh. Sex Reprod Health Matters. 2021;29(2):1885790. Al Akash R, Boswall K. Listening to the Voices of Syrian Women Refugees in Jordan: Ethnographies of Displacement and Emplacement. In: Aksaz E, Pérouse JF, editors. “Guests and Aliens”: Re-Configuring New Mobilities in the Eastern Mediterranean After 2011 - with a special focus on Syrian refugees [Internet]. İstanbul: Institut français d’études anatoliennes; 2016 [cited 2024 Aug 12]. Available from: https://books.openedition.org/ifeagd/1884 Ortiz-Echevarria L, Greeley M, Bawoke T, Zimmerman L, Robinson C, Schlecht J. Understanding the unique experiences, perspectives and sexual and reproductive health needs of very young adolescents: Somali refugees in Ethiopia. Confl Health. 2017 Nov;11(S1):26. DeJong J, Sbeity F, Schlecht J, Harfouche M, Yamout R, Fouad FM, et al. Young lives disrupted: gender and well-being among adolescent Syrian refugees in Lebanon. Confl Health. 2017 Nov;11(S1):23. Danjibo N, Akinkuotu A. Rape as a weapon of war against women and girls. Gender and Behaviour. 2019 Jul 5;17(2):13161–73. Seth K, Nanda S, Sahay A, Verma R, Achyut P. Men, The Missing Link In Gender-equitable Family Planning: A Scoping Review. Gates Open Res. 2022 Jun 22;6:73. Razzaque A. Preference for Children and Subsequent Fertility in Matlab: Does Wife-Husband Agreement Matter? Journal of Biosocial Science. 1999 Jan;31(1):17–28. Shahabuddin ASM, Nöstlinger C, Delvaux T, Sarker M, Bardají A, Brouwere VD, et al. What Influences Adolescent Girls’ Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh. PLOS ONE. 2016 Jun 23;11(6):e0157664. Guglielmi S, Seager, Jennifer, Mitu, Khadija, Jones, Nicola, Baird, Sarah. The Lives They Lead: Exploring the Capabilities of Bangladeshi and Rohingya Adolescents in Cox’s Bazar, Bangladesh | IPA [Internet]. [cited 2024 May 9]. Available from: https://poverty-action.org/publication/lives-they-lead-exploring-capabilities-bangladeshi-and-rohingya-adolescents-cox%E2%80%99s-bazar Mitu K, Jones N, Vintges J, Devonald M. Climate Risks and Truncated Opportunities: How Do Environmental Challenges Intersect with Economic and Social Disadvantages for Rohingya Adolescents in Bangladesh? Sustainability. 2022 Jan;14(8):4466. Shohel MMC. Education in emergencies: challenges of providing education for Rohingya children living in refugee camps in Bangladesh. Education Inquiry. 2022 Jan 2;13(1):104–26. Rahman MdM, Shindaini AJM, Husain T. Structural barriers to providing basic education to Rohingya children in the Kutupalong refugee camp, Cox’s Bazar, Bangladesh. International Journal of Educational Research Open. 2022;3:100159. Bartels SA, Michael S, Roupetz S, Garbern S, Kilzar L, Bergquist H, et al. Making sense of child, early and forced marriage among Syrian refugee girls: a mixed methods study in Lebanon. BMJ Glob Health. 2018;3(1):e000509. Ainul S, Ehsan I, Haque E, Amin S, Rob U, Melnikas A, et al. Marriage and sexual and reproductive health of Rohingya adolescents and youth in Bangladesh: A qualitative study. Poverty, Gender, and Youth [Internet]. 2018 Jan 1; Available from: https://knowledgecommons.popcouncil.org/departments_sbsr-pgy/460 Footnotes Individuals married prior to age 18 are automatically considered emancipated minors, due to their marital status. Participants often used “Burma” to refer to their home country, as the difference between using “Burma” vs “Myanmar” is more distinct in English. “Eve teasing” refers to the act of males making unwanted sexual remarks or advances towards a female in a public space. Note: participants did occasionally discuss the merits of marriage and childbearing from a religious or moral perspective generally, but not with regard to child marriage or early childbearing specifically. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Mar, 2025 Read the published version in Conflict and Health → Version 1 posted Editorial decision: Revision requested 30 Sep, 2024 Reviews received at journal 29 Sep, 2024 Reviews received at journal 14 Sep, 2024 Reviewers agreed at journal 09 Sep, 2024 Reviewers agreed at journal 08 Sep, 2024 Reviewers invited by journal 07 Sep, 2024 Editor assigned by journal 02 Sep, 2024 Submission checks completed at journal 02 Sep, 2024 First submitted to journal 21 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4952569","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":360884722,"identity":"dadfdd53-9104-47c0-81a8-e382764683c6","order_by":0,"name":"Kate Mieth","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Kate","middleName":"","lastName":"Mieth","suffix":""},{"id":360884723,"identity":"4253b21b-c3f7-44fe-b717-badaea256612","order_by":1,"name":"Tahia Hasan","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Tahia","middleName":"","lastName":"Hasan","suffix":""},{"id":360884724,"identity":"84960d99-0937-48c8-80e4-56baae9977a3","order_by":2,"name":"Adrija Chakrabarty","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Adrija","middleName":"","lastName":"Chakrabarty","suffix":""},{"id":360884725,"identity":"a1d5d214-f6ab-428c-abb5-9be72bc3a873","order_by":3,"name":"Kenna Lee","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Kenna","middleName":"","lastName":"Lee","suffix":""},{"id":360884726,"identity":"a11a4f90-4ab9-4cb1-aee7-2d958df7cf74","order_by":4,"name":"Adrita Kaiser","email":"","orcid":"","institution":"BRAC","correspondingAuthor":false,"prefix":"","firstName":"Adrita","middleName":"","lastName":"Kaiser","suffix":""},{"id":360884727,"identity":"9c214802-6a56-42a4-98a1-b79ff6546d00","order_by":5,"name":"Tanvir Hasan","email":"","orcid":"","institution":"BRAC","correspondingAuthor":false,"prefix":"","firstName":"Tanvir","middleName":"","lastName":"Hasan","suffix":""},{"id":360884728,"identity":"db2ffb80-b4e1-4768-b2c6-0cae43fe11f5","order_by":6,"name":"Shatha Elnakib","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Shatha","middleName":"","lastName":"Elnakib","suffix":""},{"id":360884729,"identity":"8feb0db5-8815-4e0d-a8be-6771933a6661","order_by":7,"name":"Caitlin Jackson","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Caitlin","middleName":"","lastName":"Jackson","suffix":""},{"id":360884730,"identity":"5d728b2a-54cc-49cb-a32e-997bb86a62b4","order_by":8,"name":"W. Courtland Robinson","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"W.","middleName":"Courtland","lastName":"Robinson","suffix":""},{"id":360884731,"identity":"764e3b55-6eee-4215-ae55-17057c017697","order_by":9,"name":"Linnea A Zimmerman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYBACPmYogw0mws9wBkQxY1UOVomhRbKBkBYMEYMDPAS0sPMee/ChhsGeT+x04uPKHLs844Nnj0kwVFgnNuB0GF+64YxjDMxs0rmbDc9uSy42O3AuTYLhTDoeLTxm0jxsDGxALdskG7cxJ247cMZMgrHtMH4tf/4x8AC1bP/ZuK0+cXMDSMs/AloY2xgkQLYwNm47nLiBAaSlAb8Wyd4+CQOQX4AOO54448AZY4uEY+nGuLTw8wPN/PHNxl5+du7Gj43bqhP7Z5wxvPGhxloWlxYokEBmH2BgSMCvHMNiAsaPglEwCkbBiAMAOZ5PZkpf1G8AAAAASUVORK5CYII=","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":true,"prefix":"","firstName":"Linnea","middleName":"A","lastName":"Zimmerman","suffix":""}],"badges":[],"createdAt":"2024-08-21 15:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4952569/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4952569/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13031-025-00656-2","type":"published","date":"2025-03-17T15:57:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79120499,"identity":"0955ab08-8ec1-4a7d-91a4-d28c3741dc8e","added_by":"auto","created_at":"2025-03-24 16:09:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1316622,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4952569/v1/f924d002-0556-4601-97fa-1c1b4a405350.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":" “What other option did I have?” – The effect of conflict and displacement on child marriage and early childbearing among displaced Rohingya adolescents","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eChild marriage, defined as a formal or informal union before the age of 18 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), is generally considered a violation of human rights (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite the existence of global agreements and laws intended to prevent the practice (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), approximately 19% of females globally are married before age 18, with 4% married before age 15 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Adverse consequences associated with child marriage include increased odds of intimate partner violence, restrictions on autonomous mobility, and discontinuation of education (\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Three percent of males are also married before age 18 globally (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Though there have been fewer studies that identify the adverse consequences of child marriage for males, there is evidence suggesting it is associated with lower levels of educational attainment and less awareness on sexual health topics (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChild marriage among females has consistently been associated with subsequent adolescent childbearing (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). External pressures for immediate childbearing, power structures within the family, normalization of risks associated with childbearing, protection concerns for young girls, and an increase in social status associated with having children all drive early childbearing (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). These drivers compound with adolescent girls\u0026rsquo; physical immaturity and insufficient nutrition, leading to an increased risk of mortality and morbidity for adolescent mothers and their children (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Early childbearing is also associated with higher lifetime fertility, again increasing lifetime risk for maternal morbidity and mortality (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThough limited and somewhat mixed, current research suggests that rates of child marriage may increase in humanitarian emergencies, as known drivers of child marriage are heightened or exacerbated in crisis settings (\u003cspan additionalcitationids=\"CR18 CR19 CR20\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Child marriage drivers that exist outside of humanitarian emergencies include economic uncertainty, lack of employment opportunities, and fear of sexual violence among unmarried women (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), all of which have shown to be compounded in emergencies (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Despite the negative health and gender-related consequences that are associated with child marriage, the practice is often perceived to confer benefits, such as increased physical protection from sexual and physical violence and increased economic stability. In this way, child marriage may be used as a coping mechanism to overcome adverse secondary effects of conflict and displacement (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). However, humanitarian crises have not been universally associated with increases in child marriage (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Thus, to identify effective strategies to reduce child marriage, it is critical to identify the specific trends and drivers within each local context that potentially increase demand for early marriage, and how displacement may affect these trends and drivers.\u003c/p\u003e \u003cp\u003eThere has been even less research on the direct links between child marriage and subsequent early childbearing in humanitarian emergencies (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Qualitative research in non-humanitarian settings has described the pressure that many young women face from family and partners to demonstrate fertility upon marriage (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), but few papers have explored whether these pressures are affected by humanitarian emergencies. While limited quantitative research has shown that fertility behavior can be affected by exposure to conflict (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), the mechanisms through which exposure to humanitarian emergencies affects determinants of childbearing among adolescents has been largely unexplored (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Evidence from displaced refugees has found that some women express the desire to limit childbearing, due to generalized uncertainty about the future (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), while others retain high fertility intentions regardless of displacement (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). These studies are non-specific to adolescents, however, and largely investigate changes in overall desired number of children, leaving questions about how humanitarian emergencies affect childbearing upon marriage unexplored.\u003c/p\u003e \u003cp\u003eOne population which has long suffered the primary and secondary effects of conflict and displacement is the Rohingya, who have been subjected to repeated discrimination, persecution, and violence by their home country of Myanmar since being deemed \u0026ldquo;stateless\u0026rdquo; in 1982 (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Resultingly, the Rohingya have experienced mass displacement over several waves of migration and have long sought asylum in Cox\u0026rsquo;s Bazar, Bangladesh, which now houses the largest refugee camp in the world (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In October 2016, violence from the Myanmar government heightened, and over 700,000 Rohingya fled to Cox\u0026rsquo;s Bazar throughout 2017 (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). However, Rohingya who fled in 2017 have not been granted refugee status by the Bangladeshi government and are instead referred to as \u0026ldquo;Forcibly Displaced Myanmar Nationals\u0026rdquo; (FDMN). Recent data indicate that displacement during 2017 may have increased child marriage (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), with approximately 14% of FDMN females age 18\u0026ndash;19 married before age 18 and 9.4% of FDMN males age 18\u0026ndash;19 relative to 13.3% of registered Rohingya refugee females and 0% of registered refugee males of the same age.\u003c/p\u003e \u003cp\u003ePrior to displacement, the Myanmar government prohibited Rohingya from marrying before age 18 by law. Discriminatory practices within Myanmar included placing restrictions on marriage and birth registration of the Rohingya and payment of money to military authorities (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Despite legal restrictions, however, cultural norms and traditions provided support for child marriage; as in other settings, marriage was viewed as a protective measure for girls, providing them with security and protection (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Previous studies with the Rohingya have suggested that child marriage is driven by a variety of factors, including pre-existing religious and cultural norms (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), and others which are examples of issues commonly exacerbated by crisis and camp settings (incl. economic insecurity, increased protection issues, and limited enforcement of regulations protecting human rights (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40 CR41 CR42 CR43\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Despite general awareness that child marriage is punishable by law, there is also evidence that enforcement of these laws is perceived to be looser in Bangladesh than Myanmar, leading to higher potential for child marriage (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChildbearing norms and drivers are less studied among the Rohingya. Evidence suggests that early childbearing is common; one study within Rohingya refugee camps found that 53.3% of females who married before age 18 had at least one child (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Prevalence of early childbearing is consistent with current research, as the factors known to drive early childbearing, including increased practice of child marriage, taboos around sexual relations outside marriage, and perceived loosening of child marriage laws are all present in Cox\u0026rsquo;s Bazar, but very little qualitative research has been conducted regarding early childbearing among FDMNs in Cox\u0026rsquo;s Bazar (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Even less research has been done to understand the childbearing desires and behaviors of Rohingya males, despite widespread acknowledgement that male childbearing preferences and desires influence that of their female partners (\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the complexity of the underlying drivers that affect both marriage patterns and childbearing within marriage, there is a critical need for research that explores the causal mechanisms that motivate family formation, i.e. the process from marriage into childbearing, and how this process is affected by conflict and displacement. This paper, which accompanies a quantitative paper establishing how rates of marriage and childbearing have changed amongst Rohingya FDMN adolescents, aims to identify and describe how displacement and living within a camp context has affected trends, norms, and drivers around child marriage and early childbearing, focusing primarily on the lived experience of female and male adolescents aged 15\u0026ndash;24.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eA mixed methods study was conducted from\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e2021 - 2023 in Cox\u0026rsquo;s Bazar, Bangladesh. The quantitative component was conducted by Green Hill: Community Partners International (CPI) and the qualitative component was conducted by BRAC James P Grant School of Public Health (BRAC JPGSPH) with support from CPI. Both components were supported by faculty from the Johns Hopkins Bloomberg School of Public Health, Center for Humanitarian Health. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study took place in Cox\u0026rsquo;s Bazar, Bangladesh, where one of the most populated refugee camps in the world, Kutupalong, is located. Cox\u0026rsquo;s Bazar houses nearly one million displaced Rohingya people (24, 23), of whom approximately one-third are FDMN, arriving after the latest wave of violence in 2017. Qualitative research was conducted in camps 1W, 4, and 17 of Ukhiya Upazila of Cox\u0026rsquo;s Bazar district, which were purposely chosen due to CPI\u0026rsquo;s previously-established community ties. The broader camp context is characterized by cramped living conditions, movement restrictions, and limited access to educational and employment opportunities \u0026nbsp;(48\u0026ndash;51). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative data was collected in March-April 2023. Initial participants were identified with the help of CPI who, given their wide community ties within the three camps, were able to recommend potential households where eligible adolescents were likely present. Members of the BRAC JPGSPH research team then approached these households, confirmed that eligible adolescents were present, and began conducting initial interviews. All following participants were identified and recruited via a snowball sampling method. Forty-nine (49) in-depth interviews (IDIs) and sixteen (16) focus group discussions (FGDs) were conducted with FDMNs aged 15-24 who arrived during or after October 2016 (see Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1. Qualitative Study Participants by Method, Sex, Age, and Marital Status\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"680\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No. of Interviews / Groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of Participants by Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. married\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. unmarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"25\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIn-depth Interviews\u0026nbsp;\u003c/strong\u003ew/ Participatory Timeline Activity\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"25\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e49 completed;\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;48 coded \u0026amp; analyzed*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e*one married male transcript was censored due to insufficient data\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eFemale Subtotal\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e18\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e10\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMale Subtotal\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e12\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e8\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTOTAL \u0026ndash; both sexes\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e15-17\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e1\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e4\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e18+\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e29\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e14\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e43\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAll Ages\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e30\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e18\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"25\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFocus Group Discussions\u0026nbsp;\u003c/strong\u003ew/ Participatory Venn Diagram Activity\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"25\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16 FGDs\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003econducted \u0026amp; analyzed\u003cbr\u003e\u003cstrong\u003e(6-8 participants per group)\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;10 groups of married adolescents\u0026nbsp;\u003cbr\u003e\u0026nbsp;(6 female groups; 4 male groups)\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;6 groups of unmarried adolescents\u0026nbsp;\u003cbr\u003e\u0026nbsp;(3 female groups; 3 male groups)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eFemale Subtotal\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cem\u003e40\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cem\u003e22\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eMale Subtotal\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cem\u003e26\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cem\u003e21\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTOTAL \u0026ndash; both sexes\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e15-17\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e4\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e10\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e18+\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e62\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e33\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAll Ages\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e66\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e43\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e109\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"13\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKII\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"13\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e24 conducted \u0026amp; analyzed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e18-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eFemale Subtotal\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cem\u003e13\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e18-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eMale Subtotal\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cem\u003e11\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTOTAL \u0026ndash; both sexes and all ages\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e24\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIDIs were conducted using a semi-structured interview guide and included a Life History and Timeline participatory method, in which participants were asked to outline what they considered to be the major events in their life from birth to present day. FGDs were conducted using a semi-structured interview guide and included a Venn Diagramming participatory method, in which participants were asked to rank how influential different individuals, community contexts, and local health programming are in decision-making around a variety of SRH topics, including child marriage and family planning. Both the IDIs and FGDs broadly focused on the SRH topics of marriage, childbearing, and family planning. The primary difference between the two methods was scope; the IDIs focused on the participant\u0026rsquo;s personal experience and opinions around these topics at an individual level, whereas the FGDs focused on discussing community-level beliefs and norms around these same topics. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsidering cultural norms and restrictions around movement amongst Rohingya adolescent girls, IDIs for the female participants were all conducted within the participants\u0026rsquo; residence. Two data collectors were present at the time of each interview, and researchers were instructed to conduct interviews in the most private part of the house and ask that family members allow for privacy. The data collector who was not directly conducting the interview was instructed to monitor for family members during the interviews and, in the case of interruptions, to engage them in discussions unrelated to the study until privacy could be re-established. In cases where having a private space within the home was not possible, the interviews were conducted in an area immediately outside of the home. Males were also interviewed at home, as well as at nearby tea shops, at the participant\u0026rsquo;s discretion. Because the FGDs required a long time and a specific setting so that the Venn diagrams could be conducted in separate age groups, FGDs for males, like the IDIs, were conducted at home or at CPI-provided training areas and FGDs for girls were conducted at one of the participant\u0026rsquo;s homes. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterviews with male participants were conducted by male Rohingya volunteers associated with CPI. Due to limited availability of female Rohingya volunteers, interviews with female participants were conducted by female volunteers from the host community who spoke Rohingya, were Bangladeshi nationals, and residents of Cox\u0026apos;s Bazar city. All data collectors attended a five-day qualitative training workshop, which included pre-testing the qualitative interview guides in the field and making revisions for clarity and thoroughness per participant and trainee feedback. Five field supervisors were present during the data collection process to ensure consistent implementation of the research protocol. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterview guides were developed in conjunction with community advisory boards composed of a variety of local leaders within the Rohingya community and social and cultural norms were taken into consideration to ensure that phrasing remained neutral to minimize social acceptability bias. As Rohingya and English are the primary languages spoken by Rohingya volunteers working with local humanitarian aid organizations in camp, the interview guides were provided in both \u0026ldquo;Rohinglish\u0026rdquo; (a phonetic spelling of the Rohingya language using the English alphabet) and English, so that the volunteer data collectors were able to use both languages to conduct the interview as needed. Participants aged 18 years of age or older, as well as married, emancipated\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003ei\u003c/sup\u003e participants under the age of 18, provided verbal consent prior to being interviewed. Verbal assent was collected from adolescents aged 17 and younger, in addition to verbal consent from either their parent or the eldest member responsible for the participant within the household. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval was provided by both The Johns Hopkins Bloomberg School of Public Health Institutional Review Board (FWA00000287) and BRAC James P Grant School of Public Health, BRAC University\u0026rsquo;s review board (IRB protocol no.: IRB-25 June\u0026rsquo;22-022). Due to widespread illiteracy and as Rohingya is not a written language, all participants provided verbal consent to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEnglish-language transcripts along with observational notes were reviewed, coded, and analyzed using Dedoose 9.0.107. Researchers at Johns Hopkins University and BRAC-JPG independently read English-language interview transcripts, then discussed and developed a codebook using a blended coding strategy. The codebook was primarily composed of deductive codes informed by research themes identified during a previous research project conducted in Cox\u0026rsquo;s Bazar by this research team (25), and also used as a framework for crafting the interview guides. However, researchers also cooperatively added inductive codes that would otherwise not fit within the initially-developed codebook. Memo-writing and regular reflexivity exercises were performed to minimize bias, identify emerging trends in the data, capture relationships between codes and emerging themes, and to identify gaps in the data. During the analysis phase, the team met weekly to discuss progress and develop the overarching themes that developed across codes. Once the codebook was finalized, the remaining qualitative data was coded and summaries of the coded excerpts by each code group were developed to identify trends in the findings \u0026ndash; including among participant subgroups by characteristics such as sex, marital status, age at marriage, and age at first birth.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTo better understand how conflict, displacement, and living within a camp context has affected family formation among the FDMN community, participants were first asked about their perception of current norms and drivers of child marriage and early childbearing. The participant\u0026rsquo;s description then served as a frame of reference to discuss how they felt these current norms and drivers compared to the norms and drivers that they experienced and/or witnessed regarding child marriage and early childbearing prior to displacement. \u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCurrent Norms Around Age at First Marriage \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was near consensus that marriage should occur at or after 18 years of age. However, there was also clear differentiation as to the exact age range beyond 18 for females and males. Participants more often noted that, for girls, the \u0026ldquo;ideal\u0026rdquo; age of marriage was 18 exactly, whereas for boys the stated \u0026ldquo;ideal\u0026rdquo; age of marriage generally ranged from 18-22. A few participants mentioned community stigma around being an \u0026lsquo;older\u0026rsquo; bride, though this stigma did not seem to apply to \u0026lsquo;older\u0026rsquo; grooms:\u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;People say bad things when [people] get married at an older age. If girls get married at an older age, people say they are older, but if the boys get married at an older age, they do not say anything.\u0026rdquo; -IDI23, female, unmarried, age 21\u003c/p\u003e\n\n\u003cp\u003eNo participants said that marriage before age 18 was ideal, though a few did discuss reasons why they were personally married before that age. These participants most often cited financial insecurity, familial instability, or need for social or physical protection \u0026ndash; themes which are further detailed below. \u003c/p\u003e\n\n\u003cp\u003eSome participants went on to explain why they and/or the community thought 18+ was an ideal age for marriage. Most often, they attributed this preference to protecting the physical health of women (i.e. to prevent childbearing prior to age 18) and/or to ensuring that adolescents were old enough to be \u0026ldquo;ready\u0026rdquo; for the financial (in the case of males), emotional, and social responsibilities associated with married life. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;If a couple gets married at that age [at age 18 or later], they will face no difficulties while having children; they will have proper peace in the house and will be able to handle everything. If a girl is married off before the age of 18, she will not have enough maturity about handling her emotions and treating the husband and in-laws the right way. When they turn 18, they grow this level of maturity to respect in-laws. That\u0026apos;s why it is good to marry off the girls after turning 18.\u0026rdquo; -FGD15, unmarried male age 15-24\u003c/p\u003e\n\n\u003cp\u003eHowever, the discussion around \u0026ldquo;ideal\u0026rdquo; age at first marriage was not entirely consistent with the reported typical age at first marriage within the community; many participants shared that marriage before age 18 is not uncommon. Some participants also noted that not all community members view the consequences of child marriage as negative, nor wait until adolescents have turned 18 to encourage them to marry. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;Some people say the girl would be too young to understand how marriage works [before age 18]. She won\u0026rsquo;t be able to do household chores properly and can\u0026rsquo;t solve problems. On the contrary, some don\u0026rsquo;t see early marriage as a problem. They believe a girl can learn how to maintain a family after marriage.\u0026rdquo; \u003c/p\u003e\n\u003cp\u003e-IDI33, female, married at 17, age 18\u003c/p\u003e\n\n\n\u003cp\u003e\u003cstrong\u003eImpact of Conflict \u0026amp; Displacement on Marriage Norms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was notable heterogeneity in views around the impact of displacement on community norms around child marriage. Some participants felt the average age of marriage had decreased after displacement, and that child marriages were more common now, despite camp authorities (known as the \u0026ldquo;Camp-In-Charge\u0026rdquo;, or CIC) enforcing laws preventing underage marriage. These participants most often explained this increase by communicating that there was a relative disregard for the laws restricting child marriage in Bangladesh, whereas they felt the laws which had regulated child marriage in Myanmar were more closely followed at that time. Other participants, though fewer, felt that restrictions on child marriage had instead gotten tighter since being displaced to Bangladesh, and that rates were dropping as a result. \u003c/p\u003e\n\n\u003cp\u003eMany more participants discussed the impact that conflict and displacement had had on their own marriage. When married participants were asked if and how the conflict and their displacement affected the age at which they were personally married, the majority felt that they would have been married later had they remained in Myanmar. The reasons given were the relative permissiveness of child marriage in Bangladesh as compared to the restrictions in Myanmar, conflict-related security issues, lack of educational and employment opportunities within camp, and pressure from family members to marry \u0026ndash; themes which will be discussed in greater detail, below. Most of these respondents were themselves married prior to age 18. This finding was consistent across genders. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;If I were in Burma\u003csup\u003eii\u003c/sup\u003e I wouldn\u0026apos;t have gotten married early. We wouldn\u0026apos;t have to leave Burma. In Burma, no one can marry before coming of age. But here we can do that with false documents. There are also security issues. No one knows what is going to happen tomorrow. This makes the parents very conscious and that\u0026rsquo;s why everyone is getting married earlier than they would have in Burma.\u0026rdquo; -IDI39, female, married at 17, age 18\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFewer participants said that they would\u0026rsquo;ve gotten married at the same or earlier if they had stayed in Myanmar, or that they didn\u0026rsquo;t know. Of the latter group, most felt that their marriage timing was \u0026ldquo;Allah\u0026rsquo;s wish\u0026rdquo;, implying they either didn\u0026rsquo;t have much personal control in the decision-making around marriage and/or it is not worthwhile to speculate because their life had, by-design, already gone according to \u0026ldquo;God\u0026rsquo;s plan\u0026rdquo;. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;Interviewer: Would you have married in Burma at the same age you married in Bangladesh?\u003cbr\u003e Participant: Sister, it\u0026rsquo;s all about the Almighty\u0026apos;s order. If he wanted, then it would\u0026apos;ve happened. Here Almighty\u0026apos;s order came and then happened. \u003cbr\u003e Interviewer: You think you would get married there at that age whether you came to Bangladesh or not? \u003cbr\u003e Participant: I don\u0026apos;t think about that. It\u0026apos;s all Almighty\u0026apos;s wish. If I had not come that year to Bangladesh, I might have gotten married in Burma.\u0026rdquo; -IDI30, female, married at 16, age 20\u003c/p\u003e\n\n\u003cp\u003e\u003cem\u003e \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCurrent Child Marriage Drivers \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most common current marriage drivers that participants discussed were protection from sexual, physical, and/or social harm, socioeconomic need, lack of educational and/or livelihood opportunities, and a perceived lessening of enforcements around minimum age requirements for marriage in Bangladesh as compared to Myanmar. While these themes were discussed by both male and female participants, the way that they were experienced by and applied to male and female adolescents were different, and gendered. \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProtection from Harassment, Assault, and Dishonor\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Many participants found living conditions to be both unsafe and unreliable, both within the camp and prior to being displaced in Myanmar. This was felt to be particularly salient for single girls. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;There is no safety for girls [in the camp]. Lots of gang people are there. We are afraid of them harassing young girls.\u0026rdquo; -IDI29, female, unmarried, age 21\u003c/p\u003e\n\n\u003cp\u003eIn the case of protection from sexual harassment, getting married was seen as an answer to safety concerns associated with falling victim to eve-teasing\u003csup\u003eiii\u003c/sup\u003e and other forms of sexual harassment commonly faced by young women in camp settings. Married girls were, or were at least perceived as being, more protected from such types of harassment as compared to unmarried girls. Moreover, there were fears that verbal harassment could escalate to physical sexual assault, further exacerbating the need to use marriage as a protective strategy. Notably, all transcripts which referenced safety were from female participants who were either married before the age of 18 or were unmarried themselves. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;My parents were concerned about my security as I was young and pretty. They feared something might happen to me. Getting me married was a way to ensure my safety. But I don\u0026rsquo;t know how. Anything bad could have happened even if I was with my husband. But that gave them peace, so I have no comments on that.\u0026rdquo; -IDI10, female, married at 16, age 22\u003c/p\u003e\n\n\u003cp\u003eThe threat of sexual harassment and assault was seen as one of, if not the greatest, threat to females\u0026rsquo; safety in the camp amongst community members, eclipsing other related concerns such as maternal mortality or morbidity. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;Interviewer: Why did you marry her [your sister] off so early?\u003cbr\u003e Participant: We lived in a small place with men all around us. So, there was a security problem. Thus, we decided to marry her off because we were scared for her safety and security\u0026hellip; We didn\u0026rsquo;t think about death at childbirth because it was a matter [for a] later time, while the fear of safety and security was present. So, we married her off.\u0026rdquo; -IDI44, male, married at 18, age 24\u003c/p\u003e\n\n\u003cp\u003eSome protection concerns extended to boys as well. However, these concerns more often had to do with protecting boys from the temptation to engage in activities \u0026ndash; such as harassing women or engaging in premarital sexual relationships \u0026ndash; that would bring dishonor and stigma to boys and their families, rather than protection from physical or sexual harm directed at them. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Boys can be free from doing sins if they marry earlier. They wouldn\u0026rsquo;t be involved in any love relationship or get physical with any girl if they are married off at an early age. That\u0026rsquo;s the practice here.\u0026rdquo; -IDI35, male, married at age 14, age 20 \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;At least by getting married, they [boys] have some responsibilities of their own and to stick to their family members and their wives. This is just a way to\u0026hellip; you know, keep the men attached to the family.\u0026rdquo; -IDI14, male, married at age 22, age 23\u003c/p\u003e\n\n\u003cp\u003eIn some cases, fear of single boys being more likely to engage in gang activity and/or in drug use within camp was also mentioned as an impetus for child marriage.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;My parents thought that since all my elder sisters had died, they were afraid about me. They thought, what would they do if something bad happened to me or if I became friends with the bad guys and started taking drugs or do evil things? So, they wanted me to get married and be family oriented. That\u0026apos;s why I got married.\u0026rdquo; \u0026ndash; IDI15, male, married at 17, age 19\u003c/p\u003e\n\n\u003cp\u003eIn FDMN communities, pre-marital relationships are often considered immoral, sinful, and dishonorable and can carry heavy social stigma, for both the female or male teens engaging in them and their families. Participants frequently described how the close-quarters conditions of the camps put an increasing number of adolescents in close proximity with each other. This was believed to increase the likelihood that unmarried adolescents would start \u0026ldquo;illicit\u0026rdquo; romances or affairs with each other. These \u0026ldquo;affairs\u0026rdquo; were often described as a driver of child marriage, as parents chose to marry their adolescent early to prevent adolescents from continuing to engage in pre-marital relationships that could bring shame onto themselves and their families. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;If marriages are arranged by parents, they choose girls who are [age] 18 for their sons. When marriages take place out of love and without interference from parents, girls get married between 10-15\u0026hellip; a man is usually 21 years old when the parents arrange marriage. In the case of marrying out of love, boys are between 15-18 years old when they get married.\u0026quot; -FGD9, married female age 15-24\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSocioeconomic Protection.\u003c/em\u003e\u003c/strong\u003e Marriage of girls specifically was also seen as an answer to socioeconomic instability within the household, both on the part of the girl\u0026rsquo;s household of origin and for the new husband\u0026rsquo;s household. \u003c/p\u003e\n\n\u003cp\u003eFemale participants occasionally described their parents deciding to \u0026ldquo;marry them off\u0026rdquo; to relieve the family of either the physical constrains of her family\u0026rsquo;s tight living quarters and/or to ensure her financial future. This included security in the case of her parents\u0026rsquo; death, which would otherwise strip her of continued financial support from them.\u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;Many people marry girls off, thinking about who will take care of the girl when the parents are old or die. Many people marry girls off after they are of the right age. Some are poor; others are married early because they do not have a father or a mother.\u0026rdquo; -IDI32, female, married at age 18, age 20\u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;We were living in a small house which could be a reason. We had difficulties living in such a small place\u0026hellip; \u003c/p\u003e\n\u003cp\u003eInterviewer: After your brother\u0026rsquo;s marriage, the house became more congested? \u003cbr\u003e Participant: Yes. Due to this reason, my parents decided to marry me off.\u0026rdquo; -IDI33, female, married at 17, age 18\u003c/p\u003e\n\n\u003cp\u003eMale participants often explained that they or their parents sought out a wife because their household needed someone to do the type of domestic labor traditionally ascribed to women. This was typically due to recent changes in the male\u0026rsquo;s household composition (e.g. the male\u0026rsquo;s sisters were recently \u0026ldquo;married off\u0026rdquo; and were no longer able to do these household chores and/or there was an absence of another elder female family member \u0026ndash; most often the mother \u0026ndash; who would otherwise have been able to fulfill this role, either due to illness or death). \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Our house had no heart because my sisters got married, and no one could see our sick mother. Because of that, my brother got married\u0026hellip;he was married early so his wife could take care of our mother and do the work that our mother could not do.\u0026rdquo;-IDI26, unmarried, age 22\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e \u0026ldquo;Yes, [I got married] because my mother died. I have two younger siblings. So, my father said that they will become helpless.\u0026rdquo; -IDI4, male, married at age 16, age 21\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;There is no one else in my family except me. I have to serve my parents. I have to work. I must serve them and earn money. I got married so that I would have someone at home to look after my parents when I\u0026rsquo;m out working\u0026rdquo; -IDI20, male, married at age 18, age 18, no children\u003c/p\u003e\n\n\u003cp\u003eDowries (and the inability to afford them) also came up in a highly gendered way, with the majority of transcripts mentioning dowries being from unmarried female participants. Of the participants who discussed dowries, around three-fourths reported there was a dowry exchange for their female family members, whereas around one-fourth reported no dowry exchange. Dowry was frequently mentioned as a barrier to marriage for girls (i.e. the bride\u0026rsquo;s family being unable to provide a dowry, despite their desire for their daughter to marry). Participants occasionally mentioned families resorting to loans to pay their daughter\u0026rsquo;s dowry, or sending their daughters to Malaysia so that they could get married without having to pay dowry. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;There are lots of girls who belong to poor families that can\u0026apos;t get married [due to the dowry system]. They marry their girls off when they save some money. If they can\u0026apos;t do that, they marry them off by taking loans\u0026hellip;if they can\u0026apos;t get them married here [in Bangladesh], they send them off to foreign countries by marrying them off with men who are much older than them\u0026hellip;her parents forcibly marry her off even if she\u0026apos;s not agreed.\u0026rdquo; -IDI29, female, unmarried, age 21\u003c/p\u003e\n\u003cp\u003eA few participants mentioned that dowry isn\u0026rsquo;t always expected because families commonly deal with financial hardship within camp, but this seemed to be more an exception rather than a rule. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Those who have jobs get proper salary every month they give more dowry than others. They give mobile phones and money. Those who are poor don\u0026apos;t have money to give dowry. Also, there are some people who understand [so] they don\u0026apos;t demand dowry.\u0026rdquo; -IDI28, female, married at age 16, age 19\u003c/p\u003e\n\n\u003cp\u003eOnly two participants explicitly mentioned dowry as a clear motivator in their decision to get married \u0026ndash; one a married male whose family needed additional finances, and one an unmarried girl who was accusing boys\u0026rsquo; families of being greedier about dowries than they were in Myanmar due to their own scarce resources in camp. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;[My bride] was only 13 years old. But I had nothing else that I could do [to support my family\u0026rsquo;s financial needs]. I had to marry for the sake of my family members.\u0026rdquo; -IDI35, male, married at age 14, age 20\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLack of Education and Livelihood Opportunities.\u003c/em\u003e\u003c/strong\u003e \u003c/p\u003e\n\n\u003cp\u003eMany male participants expressed great frustration at the lack of educational and career opportunities in camp, citing rules which prevent FDMNs from engaging in formal employment opportunities and a lack of formal schooling options within camp. This was often described as a reason parents encouraged their adolescent children to get married, as adolescents had few other options for occupying their time and contributing to the community. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;My family wanted [my brother to marry]. His study has also stopped and there\u0026apos;s not much to do here. So, my parents thought it would be better if he got married and started his own family.\u0026rdquo; \u0026ndash; IDI1, Male, unmarried, age 20\u003c/p\u003e\n\n\u003cp\u003eThis lack of education and livelihood opportunities also occasionally tied into the aforementioned protection issues for boys specifically, as \u0026ldquo;having nothing to do\u0026rdquo; was seen as a risk factor for engaging in sexual harassment or gang activity. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;There is no activity here in the camp. So, boys get married at the age of 17/18. The reason for doing this is that they cannot study much here. Cannot go to college after class 10 due to rules and a lack of opportunities. So, they do not study or do business or work. Then, while not doing anything like that, they get involved in bad deeds. That is why they get married.\u0026rdquo; -IDI14, male, married at age 22, age 23\u003c/p\u003e\n\n\u003cp\u003eYet even the few male participants that described being able to find income-generating opportunities despite the restrictions and access issues were often not able to overcome other drivers for child marriage. For example, their having work left a gap in caretaking and household responsibilities, thus tying back into seeking a wife to fulfill those roles in their absence. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;In 2017, we came to Bangladesh from Myanmar. We [young boys] had nothing to do [upon arriving]\u0026hellip; I wanted to study, but I couldn\u0026rsquo;t. My father told me to work in his shop\u0026hellip; [but] someone had to take care of the household chores, take care of my parents, maintain the house, and do everything. My parents cannot do that anymore. I am in the shop the whole day. What other option did I have [but to find a wife]?\u0026rdquo; -IDI3, male, married at 18, age 19\u003c/p\u003e\n\n\u003cp\u003eVery few female participants expressed a similar frustration with the lack of educational and livelihood opportunities. However, participants occasionally mentioned that, because girls are culturally expected to stop going to school once they reach menarche, they are then forced to stay within the house for the majority of their adolescents, which can be \u0026lsquo;concerning\u0026rsquo; for their families.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;There is another reason for marrying off girls before 18. A girl becomes a maiden [reaches menarche] by the age of 15. So, from 12 to 15 years old, we [would already] have to keep her at home for 3 years after becoming a maiden, let alone [until] 18 years old. They stay at home for 3 years [minimum]. Within this time, if she doesn\u0026apos;t get a chance to have an education, if she doesn\u0026apos;t have any other work, she sits idly at home. A maiden girl sitting at home is a matter of concern for parents\u0026hellip; [Girls often] have to stay [within the home for] 6 years, which is very long\u0026hellip; That is why we marry off our daughters early.\u0026rdquo; -FGD14, married male age 15-24\u003c/p\u003e\n\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLimited Enforcement of Minimum Age Requirement for Marriage. \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany participants felt that age requirements for marriage were easy to circumvent in the camp setting. For example, several female participants who were married prior to age 18 admitted that they (and/or their family) purposefully lied about their age, forged documents, and/or did not notify the CIC of their marriage, to avoid penalization or repercussions. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;I was 13 when I got married\u0026hellip; [my mother and in-laws] arranged a fake birth certificate for my marriage and according to this certificate, I am 19.\u0026rdquo; -IDI47, female, married at 13, age 15\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Some people are still getting married at a young age by showing false documents. They [also] often get married, but don\u0026apos;t register it to CIC until they are of age.\u0026rdquo; -IDI48, female, married at 17, age 18\u003c/p\u003e\n\n\u003cp\u003eHowever, other participants felt that the CIC was able to adequately restrict child marriage within camp. Most often these were male participants. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;No, people can\u0026apos;t get married whenever they want to, as CIC made restrictions on early marriage. They forbid those girls who are below 18 and the boys who are below 21 to get married. And we need their permission to get married.\u0026rdquo; \u0026ndash; IDI1, male, unmarried, age 20\u003c/p\u003e\n\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact of Conflict \u0026amp; Displacement on Marriage Drivers \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Eloping out of love is one reason for [child] marriage. Some parents can\u0026rsquo;t afford the expenses of their daughters and decide to marry them off [early to relieve their financial condition]. The death of the parents is another reason for early marriage\u0026hellip; [but] if [the girl\u0026rsquo;s] parents can\u0026rsquo;t afford a dowry, they can\u0026rsquo;t marry their daughters off.\u0026rdquo; -FGD9, married female age 15-24\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOn Protection-Related Drivers. \u003c/em\u003e\u003c/strong\u003eMany participants felt that, while some protection-related issues were present prior to displacement, protection concerns have significantly increased within the community due to the camp setting post-displacement. \u003c/p\u003e\n\n\u003cp\u003eFor girls, the use of marriage as a form of protection in the face of uncertain and unsafe conditions seemed to have also been present in the FDMN community prior to their displacement to Bangladesh; some participants described that a lack of safety in their home villages similarly drove decision-making around child marriage. However, in this context, the threat of sexual violence was described to be less-so from other community members, and more a threat from those who were assaulting their villages. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;When they burnt our villages and godowns and everything. Amidst the massacre, I was married off. The people got scared. They were killing everyone. Young girls were getting tortured. My parents also got scared about our security. I was young and beautiful, you know? There was more risk of being tortured.\u0026rdquo; -IDI9, female, married at 12, age 18\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Interviewer: So, after the violence in your village, your parents decided to get you married? \u003cbr\u003e Participant: Yes, that\u0026rsquo;s why they got me married. It was not very secured to have an unmarried girl at home in that tense situation. Everyone was doing the same.\u0026rdquo; -IDI9, female, married at 12, age 18\u003c/p\u003e\n\n\u003cp\u003eBy contrast, participants frequently described how the camp setting put adolescents in closer-proximity with each other more often than they ever experienced previously in Myanmar, increasing the threat of protection-related concerns from within their own community. Participants often explicitly tied the close-quarters nature of the camp setting to increased levels of eve-teasing and sexual harassment on the part of boys, increased safety concerns for girls when spending time outside of their home, and a notable increase in the likelihood that adolescents entered into the types of pre-marital relationships that drove their parents to want to marry them as quickly as possible to each other, regardless of their age, for fear that their relationship would bring shame unto their families via inappropriate social contact, pre-marital sex, or an unintended pregnancy. \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOn Socioeconomic Drivers. \u003c/em\u003e\u003c/strong\u003eMany participants also described the effect that conflict and displacement had on socioeconomic drivers, and the results were also highly gendered. For girls, participants most often described that being displaced had increasingly strained their family\u0026rsquo;s financial and living situations, effectively pushing unmarried adolescent girls out of their household of origin to alleviate those strains. \u003c/p\u003e\n\u003cp\u003e\u003cem\u003e \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmongst both genders, participants often implied that the conflict and displacement had put their family members at increased risk of becoming sick or passing away due to poor migratory conditions and living conditions within camp. For boys, this translated to an increased likelihood that they would need to find a wife to \u0026ldquo;replace\u0026rdquo; female family member who were no longer able to take care of other ill family members and/or perform regular household chores. For girls, this translated to increased fear that the household of origin would not be able to financially provide for them, further increasing the likelihood that her family would be incentivized marry her off. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;When I was in Burma, my parents didn\u0026apos;t have to be taken care of, I didn\u0026apos;t have to support my parents because we had more relatives and more property\u0026hellip; I would not have to support my family [in Myanmar], I could have stayed with my studies. I could have reached my goal. After coming here, my parents became ill, I was forced to get married to help my parents\u0026hellip; I have to feed them with my income. If I take care of my parents, we don\u0026apos;t have food to eat. That\u0026apos;s why I had to get married. My wife takes care of my parents, and I work and earn a living.\u0026rdquo; -IDI20, male, married at 18, age 18\u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;Interviewer: If you were in Myanmar, you [said you] wouldn\u0026rsquo;t have gotten married, but in Bangladesh you did. Why wouldn\u0026rsquo;t you have gotten married there?\u003cbr\u003e Respondent: Here, I can\u0026rsquo;t go anywhere. We earned money there, but here we can\u0026rsquo;t earn enough money. We had so many jobs available in Myanmar, but we don\u0026rsquo;t have such options in Bangladesh... Also, my parents became sick after coming here. I think the whole process of leaving our village was a lot to take for both of them. They have never been the same after that. I would have never married at this age if it hadn\u0026apos;t been for them. I could have enjoyed my life the way I wanted to in Myanmar. -IDI3, male, married at 18, age 19\u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;Here [in Bangladesh] we don\u0026rsquo;t have money. We are living by managing to take money or food from here and there. Yes, people marry off their daughters [at early ages] due to a shortage of money.\u0026rdquo; -FGD4, unmarried female age 15-24\u003c/p\u003e\n\n\u003cp\u003eParticipants generally agreed that expectations around dowry had increased in Bangladesh as compared to Myanmar, despite more families having comparatively less capital in the camps. However, there was disagreement regarding whether this was universally true or enforced, and the affect (if any) on rates of child marriage. In fact, there was some evidence that the increased dowry price may have prevented child marriage for girls who would\u0026rsquo;ve otherwise been married had their families been able to provide a sufficient dowry. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;Interviewer: Was dowry common in Burma?\u003cbr\u003e Participant: Yes. But after coming here it has been increased. Like, in 2017/2018 it was not that high. Gradually the amount of dowry increases. It is a huge burden for us. Especially for the people who do not have a proper earning source. \u003cbr\u003e Interviewer: What is the reason for it?\u003cbr\u003e Participant: Some people do illegal jobs here. They can earn more. So they give a huge amount of dowry for their daughter\u0026rsquo;s or sister\u0026rsquo;s marriage. So people became greedy now. They want more and more. Not only money but also gold, phone, and furniture. For example, now people know that they can get many things from a dowry easily. So, it became a trend here. The more you can give the more your demand is for marriage. My father has died and my brother is married. We don\u0026rsquo;t have that much money to give and arrange all these things. This is the reason why my marriage could not take place.\u0026rdquo; -IDI19, female, unmarried, age 19\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOn Education and/or Livelihood Opportunities.\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e \u003c/em\u003eMale participants drew clear distinctions between the availability of livelihood opportunities pre- vs. post-displacement, saying that the stark lack of livelihood opportunities has only been present since moving to Bangladesh. Participants also tied this back to boys being more at-risk for engaging in eve-teasing and other inappropriate behavior because they were not otherwise busy with school and/or work. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Participant: It would be good if there is a factory as there are so many jobless young boys. They tease the girls and sit idly here and there. It would be stopped if many of them could get to work\u0026hellip;\u003cbr\u003e Interviewer: Was it like this also in Burma?\u003cbr\u003e Participant: there, they didn\u0026apos;t get the chance to do these things as they were busy with their business and others. Here they are jobless, so they do all the wrongdoings.\u0026rdquo; \u0026ndash; IDI1, male, unmarried, age 20\u003c/p\u003e\n\n\u003cp\u003eMany male participants described their educational and professional dreams prior to the conflict and displacement, and how they were forced to give up those dreams because of lack of access to education and restrictions on working as a refugee within camp. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;I was very sad [to leave Myanmar]. I had to leave my own home, land, and life. I had to stop studying\u0026hellip;[In Myanmar I would have studied] to the highest level I could. I wanted to be a doctor, but I had to let go of my dream after coming here.\u0026rdquo; \u0026ndash; IDI1, male, unmarried, age 20\u003c/p\u003e\n\n\u003cp\u003eParticipants who seemed most discontented by the lack of educational opportunities were those who had made progress in achieving their educational and professional goals in Myanmar. More often, these were relatively older participants who had migrated at a point where they were close to finishing their studies and were forced to stop before completion. These participants sometimes expressed that, because they were unable to finish their studies and were comparatively closer to a marriageable age than their younger peers, they \u0026ldquo;had to\u0026rdquo; get married earlier in Bangladesh than they would have in Myanmar. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;If all goes well, a boy passed matriculation at the age of 16 in Burma. As I passed matriculation in 2016, I would have been able to study for another four to five years. I could study at university. I got admission at the university\u0026hellip; If I had been in Burma, I would have continued my studies. That\u0026apos;s why there\u0026apos;s been a lot of difference. Not being able to read has caused a lot of damage to my community, to myself, and to my family. I can\u0026apos;t support my family as much as I was supposed to. My mentality did not improve as I could not study\u0026hellip; If I were in Burma, I would have studied\u0026hellip;but after coming to Bangladesh in 2022, due to the society, due to the situation, I had to get married. It\u0026apos;s been a big difference to me.\u0026rdquo; -IDI21, male, married at 23, age 24\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;I wanted to study up to class 10 in Burma and get admitted to college. After getting higher education, it was my desire to open a big school and [then] run the family. I have been forced to come here, and I have to work, so there is no time to go to college here, no school, I have studied up to class 10 here. I couldn\u0026apos;t reach my goal. I had to get married to serve my parents. I couldn\u0026apos;t meet my goal because of all this.\u0026rdquo; -IDI20, male, married at 18, age 18\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBy contrast,\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003egirls were restricted from education during much of their adolescent years even in Myanmar prior to the conflict or displacement, due to cultural norms around girls exiting school once reaching menarche. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;There was a custom in Myanmar among our people when we lived there. Girls weren\u0026rsquo;t allowed to attend school once they turned 12 or 13. These girls were thought to be too old to continue studying. I had to quit for the same reason\u0026hellip;When girls go through puberty, it indicates the time to stop studying. The family members do not allow the girl to go to school. We can\u0026rsquo;t go against them\u0026hellip; My parents forbid me to continue studying, and I felt I shouldn\u0026rsquo;t study anymore.\u0026rdquo; -IDI33, female, married at 17, age 18\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOn Enforcement of Minimum Age Requirements for Marriage.\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e \u003c/em\u003eParticipants often directly compared the restrictions around marriage prior to age 18 in Myanmar to those in Bangladesh, and described similarly variable levels of compliance. However, there was not clear consensus regarding whether participants perceived restrictions as being more, less, or similarly strict to those in Bangladesh. More participants felt that marriage restrictions in Bangladesh were looser or relatively nonexistent as compared to those in Myanmar, and subsequently felt this was increasing child marriage rates. Yet, others described a perceived tightening of marriageable age restrictions and their enforcement in camp due to stricter monitoring by the CIC. Participants from Camp 1W and Camp 4 more often described the CIC as being strict in this way. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;In Burma, [girls] could not marry before the appropriate age\u0026hellip; [or else she] would be jailed. I think some girls are married off at an earlier age [in Bangladesh] because there are no laws about it. No restrictions on it.\u0026rdquo; -IDI32, female, married at age 18, age 20\u003c/p\u003e\n\n\u003cp\u003e\u003cem\u003e \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCurrent Childbearing Norms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Most [girls] have a baby quickly [after marriage, regardless of their age at marriage]\u0026hellip; In this way, it is better to have a second child five years after having the first child\u0026hellip; to keep the [mother\u0026rsquo;s] body healthy. [But soon] after getting married, the first baby has to come into the stomach\u0026hellip; [because] if you have a child, affection is born in the mind of the husband\u0026hellip; and he will no longer marry anyone outside [of the original marriage].\u0026rdquo;-FGD5 participant, married female age 15-24\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTime to First Birth.\u003c/em\u003e\u003c/strong\u003e Participants universally described the societal expectation of initiating childbearing shortly after marriage, and typically within the first year of marriage. The pursuit of having children within the first year of marriage was shared by both married women and men, further illustrating the strength of the norm around demonstrating fecundity immediately after marriage and thus the resistance to delaying first birth across both genders. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The year you get married, you have children. If you marry at the age of 18, you have a child at the age of 18, and if you marry at the age of 20, you have a child at the age of 20\u0026hellip; you [always] have a child in the first year of marriage. This is the culture of our Rohingyas. [This is because] parents think that when [their married children] are older, they will not be able to raise their [own] children well. Grandparents want to see their grandchildren\u0026apos;s faces.\u0026quot; -FGD2, married male age 15-24\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;My husband, in-laws, parents, and neighbors give me suggestions for conceiving. They say one should have a child as soon as possible after marriage. It\u0026apos;s good for the couple to have a stronger bond.\u0026rdquo; -IDI48, female, married at 17, age 18, no children\u003c/p\u003e\n\n\u003cp\u003eThe only accepted exception to this norm was in certain cases where girls were married very young. However, child marriage did not universally exempt younger brides from fulfilling what was considered their wifely obligation/duty.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;People who are [married] young should take birth control pills because at that age our body is not healthy enough to have a child. People call it a sin. But it\u0026apos;s not the case. But people who want to do it do it anyway\u0026hellip; I think [taking birth control] should be done because of concern for a mother\u0026apos;s health and well-being.\u0026rdquo; -IDI43, female, married at 17, age 21, 1 child\u003c/p\u003e\n\n\u003cp\u003eFears of the consequences of delaying first birth included social stigma (ie. other community members judging and gossiping about couples for not having children earlier), not solidifying the bond between husband and wife, marital arguments, and girls specifically being accused of being infertile or \u0026ldquo;barren\u0026rdquo;. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;There were neighboring women near the house, and they advised my wife to have a child as soon as possible. All of them said it\u0026rsquo;s best to have a child immediately after getting married. If we delay the process, there is a chance that we will never have a baby. You can say this is the culture here or the practice\u0026hellip; So, I had to follow that too.\u0026rdquo; -IDI24, male, married at age 17, age 19, 1 child \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;When I wasn\u0026rsquo;t pregnant 1-2 years after the marriage, everyone started to talk bad things about me. That I cannot have a child, I am a \u0026ldquo;Baja\u0026rdquo; (infertile) woman and my husband should be remarried. My neighbors, relatives\u0026hellip;everyone was bad mouthing me.\u0026rdquo; -IDI9, female, married at 12, age 18, 1 child\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;If we don\u0026apos;t have children after we get married, we will then spend a long time taking birth control pills. That is seen negatively in our community and people pass many kinds of comments. Another thing is, if we don\u0026apos;t have children after marriage, there arises any kind of conflict between husband and wife. So if we have a child, I will feel more affection towards my wife and I will be more responsible for my family. If, after we try to have a child, we can\u0026apos;t get pregnant, then we will fight a lot. As [another participant] said earlier, we should have a child as soon as possible [after marriage]. There is no gain in being embarrassed. Husband and wife desire to have a child right?\u0026rdquo; -FGD1, married male age 15-24\u003c/p\u003e\n\n\u003cp\u003eAnother perceived consequence of not having a child soon after marriage was the threat of a husband seeking a second wife (ie. choosing to enter into a polygamous marriage) with the rationale being that a second wife might be able to provide him with a child as an alternative. Female participants often described choosing to have a first child quickly after marriage as a tool to keep her husband invested in their relationship. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;Some men actually marry again [seek another wife] if their [first] wives can\u0026rsquo;t conceive a child. It is common in this society.\u0026rdquo; -IDI33, female, married at 17, age 18, no children\u003c/p\u003e\n\n\u003cp\u003eDespite this strong societal expectation to demonstrate fecundity immediately after marriage, several IDI participants did specifically mention wanting to (or wishing that they could) delay childbearing and not have children right after marriage; all of these were women, and all but one were married before age 18. There was also a number of participants, particularly those who participated in FGDs, who said that it would theoretically be ideal to wait until age 18-20+ to start having children, especially for women. Reasoning typically included to preserve the health of the mother and to ensure that the couple was \u0026ldquo;prepared\u0026rdquo; or \u0026ldquo;matured enough\u0026rdquo; to be parents themselves. However, this was often underpinned by discussions that demonstrated that societal expectations around shorter times to first birth almost always took precedence over personal preference. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;I wanted to wait a few more years before having any babies. But I was bound to at that time.\u0026rdquo; -IDI9, female, married at 12, age 18, 1 child\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFertility Rate, Birth Spacing, and Family Planning.\u003c/em\u003e\u003c/strong\u003e By contrast, participants described there being significantly more leeway in decision-making around childbearing after the birth of their first child. After the birth of their first child, young couples were seemingly given more space to make their own decisions on desired number of children and preferences around birth spacing, without the same level of heavy societal pressure from community and other family members. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;[My in-laws] don\u0026rsquo;t want us to take another baby right away. They know how much pain I had to endure during the birth of my first baby at such an early age. So, they told us to wait until our first child grows up.\u0026rdquo; -IDI8, female, married at 17, age 19, 1 child\u003c/p\u003e\n\n\u003cp\u003eWhen asked, many participants explicitly stated wanting to wait somewhere between 3-6 years between their children. This desire was mostly motivated by considerations of the mother and living children\u0026rsquo;s health and was discussed by both male and female participants. Family planning was fairly openly discussed as a way to achieve desired birth spacing. Participants more often described family planning as being beneficial, particularly in promoting the health of mother and child. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;My first child was born unplanned. To avoid another unwanted pregnancy, I am taking [birth control] pills. If I conceive another child, then none of my kids will get a better life. After my firstborn is all grown up, I will think of taking another child. If I take another child now, then there is a huge chance both of them will get sick. -IDI7, female, married at 19, age 20, 1 child\u003c/p\u003e\n\n\u003cp\u003eUse of family planning seemed to be significantly less stigmatized after the birth of a first child than prior to first birth, though a few participants did mention religious stigma and family planning being considered a sin. \u003c/p\u003e\n\u003cp\u003e\u0026ldquo;After marrying, I will have a child. After [my first child is born], if I think it\u0026apos;s necessary, I will use family planning, but not before that.\u0026rdquo; -FGD1, married male age 15-24\u003c/p\u003e\n\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact of Conflict and Displacement on Childbearing \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026ldquo;\u003c/strong\u003eInterviewer: Are people having children at the same age here? \u003c/p\u003e\n\u003cp\u003eParticipant: Yes. But they could have had more in Burma; they are having less children here. There is no place to stay, there is no arrangement for education, and there is no food. In short, you can\u0026apos;t feed, you can\u0026apos;t teach, there\u0026apos;s no income - that\u0026apos;s why people are having fewer children.\u0026rdquo; -FGD13a, married female age 15-24\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOn Time to First Birth.\u003c/em\u003e\u003c/strong\u003e When asked about the effect the conflict and/or displacement has had on childbearing, no participants discussed time to first birth, nor described there being any difference in the pressure to demonstrate fecundity soon after marriage in Bangladesh as compared to Myanmar. \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOn Fertility Rate, Birth Spacing, and Family Planning.\u003c/em\u003e\u003c/strong\u003e Almost all participants, however, agreed that couples were having far fewer children and engaging in family planning more in Bangladesh than they did in Myanmar. Many attributed this to an increase in access to health education and family planning methods, as compared to what was available in Myanmar. \u003c/p\u003e\n\n\u003cp\u003e\u0026ldquo;In Myanmar, married couples may want to have 6 to 7 children. Here they want to have 2 to 3 children so that the children can be healthy.\u0026rdquo; -IDI47, female, married at 13, age 15, 1 child\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;In Burma, people used [family planning] less than in Bangladesh, the rate of using family planning methods has increased here. [In Myanmar] there was just 1 method [available], which was injections [Depo-Provera]. People didn\u0026rsquo;t know about other methods, or even if others existed. They also didn\u0026apos;t consult the doctor about family planning methods. Here, couples discuss family planning and go to the hospital and [community health volunteers] come here [to our homes] frequently.\u0026rdquo; -FGD8, unmarried male age 15-24\u003c/p\u003e\n\n\u003cp\u003eMany of the participants cited one or more constraints to childbearing within the context of living in camps specifically, the most common being a lack of educational opportunities for children, followed by lack of space for children to live in and/or play, followed by shortage of money/income, and poor access to health services. These sentiments were strongly held and evenly shared by both male and female participants. Less commonly-discussed constraints were general instability due to the conflict and not wanting their child to grow up without a home country.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Here [in Bangladesh] we decide to have fewer children. We don\u0026rsquo;t have our own house here, and it is not certain how long we can stay here. We may have to go back [to Myanmar] if we are told to do so. Moving with lots of children is difficult. Due to these reasons, married couples have 2 to 3 children instead of 4 or 5 children. Men also don\u0026rsquo;t have any work here. They won\u0026rsquo;t be able to bear the expenses of many children. This is also a reason.\u0026rdquo; -FGD9, married female age 15-24\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We are living in a foreign country right now. We are refugees. We won\u0026rsquo;t be able to educate our children properly, as there are no provisions for education here. Besides, rearing many children will be difficult here. We may not get proper medical treatment\u0026hellip; and look at our houses. We don\u0026rsquo;t have enough space to have many children. Where will they stay when they grow up?\u0026rdquo; -IDI33, female, married at 17, age 18, no children\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;If I have a child [like my parents want me to], the child will receive no birth certificate here [in Bangladesh] because we are refugees\u0026hellip; If the children ask their parents where our country is, we can\u0026apos;t show it. So, [displacement is] causing much damage to us.\u0026rdquo; -IDI20, male, married at 18, age 18, no children \u003c/p\u003e\n\n\u003cp\u003eOnly a few participants stated that they felt there had been no impact of conflict and displacement on the average number of children couples were having, of them, most stated that childbearing is up to \u0026ldquo;God\u0026rsquo;s Will\u0026rdquo; rather than personal decision-making or circumstance. \u003c/p\u003e\n\n\u003cp\u003e[1] Participants often used \u0026ldquo;Burma\u0026rdquo; to refer to their home country, as the difference between using \u0026ldquo;Burma\u0026rdquo; vs \u0026ldquo;Myanmar\u0026rdquo; is more distinct in English. \u003c/p\u003e\n\u003cp\u003e[2] \u0026ldquo;Eve teasing\u0026rdquo; refers to the act of males making unwanted sexual remarks or advances towards a female in a public space.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur research demonstrates that conflict and displacement have amplified some previous drivers of child marriage and especially practical drivers, such as concerns of sexual violence and the socioeconomic incentives surrounding marriage. In other cases, conflict and displacement have introduced new drivers, such as concerns of increased illness and mortality among family members and severely limited education and livelihood opportunities (for boys specifically). However, conflict and displacement appeared to have no impact on the norms of girls getting married younger than boys, nor the pace of the transition from marriage into parenthood, though it appeared to strongly reduce the total number of children desired as a response to severe living conditions. \u003c/p\u003e\n\n\u003cp\u003eWe found consensus that the \u0026lsquo;ideal\u0026rsquo; age of first marriage for girls was 18 exactly and was slightly older for boys, The consistent and explicit mention of age 18 exactly likely points to our participants receiving strong messaging from either the CIC, local NGOs, or both reinforcing that 18 is the minimum legal age of marriage. While our findings echo the findings of a previous study conducted by Islam et. al, (37) which also found a strong preference for 18 as the minimum ideal marriageable age, another study conducted by Melnikas et al. (38) just one year earlier had found a stronger preference for marrying prior to age 18 amongst community members. It is unclear if social desirability bias may partially explain our findings, or if participants have genuinely adopted the messaging surrounding \u0026ldquo;ideal\u0026rdquo; minimum age at marriage. \u003c/p\u003e\n\n\u003cp\u003eOur qualitative findings mirror our quantitative findings \u0026ndash; see: \u0026ldquo;Family formation among adolescent Rohingya refugees; Understanding trajectories into adolescent marriage and childbearing in Cox\u0026rsquo;s Bazaar Bangladesh\u0026rdquo; \u0026ndash; which found a sharp increase in risk of marriage at age 18 exactly for girls. These combined findings may point to a strong trend within the community towards getting married at age 18 exactly (especially for girls), or potentially a tendency to report a marriage once the bride and/or groom have turned 18. However, both our qualitative and quantitative results also demonstrate that child marriage remains common and accepted within this community, particularly for girls, and that girls tend to marry younger than boys. This is likely at least partially due to the cultural stigma that is put on \u0026ldquo;older\u0026rdquo; brides that does not exist in the same way for boys, which has also been similarly demonstrated in previous research (37,38). \u003c/p\u003e\n\n\u003cp\u003eParticipants largely reported that conflict and displacement had led to an increase in child marriage within the community, and most married participants felt that they would\u0026rsquo;ve married later had they stayed in Myanmar and had not been affected by the conflict. Interestingly, perceptions of increasing child marriage rates are seemingly not reflected in our quantitative findings, which showed lower rates of child marriage amongst adolescents aged 15-19 than aged 20-24. One explanation for this discrepancy could be that recently-married adolescents who are younger than age 18 would be less likely to report their marriage in the survey, and thus our quantitative findings are only observing a decrease in reported rates of child marriage, not actual rates. Our qualitative research also asked about the change in child marriage due to conflict and displacement more generally, meaning that qualitative participants were likely comparing current rates of child marriage to those that occurred \u003cem\u003ebefore\u003c/em\u003e the latest wave of violence in 2017, while quantitative findings compared between age cohorts, but not by specific years. It could be that during the onset of conflict in 2017, child marriage rates increased from what they were pre-conflict, but decreased somewhat once families were settled in Bangladesh \u0026ndash; though never declining to the levels that existed prior to displacement. This would be supported by our qualitative results, as several participants mentioned that more girls were married at the onset of the latest wave of conflict because of the immediate threat of violence and sharp rise in overall uncertainty. \u003c/p\u003e\n\n\u003cp\u003eOverall, our qualitative findings related to child marriage drivers indicate that, while some drivers within the Rohingya community have either continued or have been exacerbated across pre- and post-displacement settings (e.g. security concerns) others (particularly religious considerations) may have been at least partially replaced or obscured by practical considerations, given the camp context. In other words, early marriage appears to largely serve as a tool to improve uncertain and vulnerable situations for Rohingya adolescents and their families, rather than an ideal or spiritually superior situation by which to form a family. The rationales by which this tool was employed, that is, the motivations why a girl or boy would be married early, were highly gendered, however. \u003c/p\u003e\n\n\u003cp\u003eFor girls, concerns of sexual, physical, and/or social harm were paramount. This was particularly salient in the camp setting, where conditions are generally considered unsafe, and especially so for unmarried adolescent girls. This is consistent with other literature (38,52) that highlights the role of marriage as a necessary tool for protection from physical and sexual violence amongst the Rohingya \u0026ndash; both pre- and post-displacement. One more unique finding from our research was that marriage was also often viewed as a tool to protect boys from perpetrating immoral acts (eg. eve teasing) and/or violence themselves. Thus, child marriage was more a tool that dissuaded \u0026ldquo;bad\u0026rdquo; behavior, that would otherwise dishonor themselves and their families, and instead allowed them to secure positive and respected status as a husband within their community. For both genders, marriage was a way to rectify premarital relationships forming against parental will. Similar themes around using marriage as a tool to preserve family honor and premarital purity were similarly described by several other studies conducted with Rohingya adolescents (37,38,53), underpinning the strength and consistency of this driver. \u003c/p\u003e\n\n\u003cp\u003eThis was the single strongest moral/religious consideration for child marriage discussed by our participants, though it more described child marriage as a method to \u003cem\u003eavoid or correct\u003c/em\u003e immoral actions on the part of the adolescents/young adults (e.g. eve-teasing, participating in a pre-marital relationships), rather than argued the inherent morality or benefits of marrying early.\u003csup\u003eiv\u003c/sup\u003e This illustrates a potentially key window of opportunity for practioners to develop and encourage alternative outlets for adolescent boys, (perhaps skills-building or community groups) as a way to avoid \u0026ldquo;immoral\u0026rdquo; activities by engaging them in societally-respected activities instead of marriage. \u003c/p\u003e\n\n\u003cp\u003eMarriage also served as a major socioeconomic tool. In the otherwise economically limited camp context, girls served in some ways as a socioeconomic currency, benefitting both the household of origin, by reducing consumption and increasing space, and the husband\u0026rsquo;s home, by providing dowry and conducting gendered household labor. This often made marriage mutually beneficial to both families from a financial standpoint. Using marriage as a means to alleviate family burden has been similarly found in previous research amongst Rohingya adolescents (38). \u003c/p\u003e\n\n\u003cp\u003ePatriarchal gender norms regarding gendered labor within the household also play a large factor in this marriage economy. Females are expected to take on traditional household and caretaking duties, whereas men are expected to act as the traditional breadwinners. As a result, boys and their families often sought brides to provide household labor when other females (especially the boys\u0026rsquo; mother or elder sisters) were reportedly unable to provide this household service due to death or illness. This was seemingly true even when boys were otherwise unoccupied due to lack of educational and or livelihood opportunities themselves. Thus, many male participants expressed a need to get married to help their sick family. As participants felt that the conflict and their displacement experience put their older family members at increased risk for illness and death, this mechanism was explicitly tied to the conflict and displacement and was a common explanation for why participants felt they married earlier in Bangladesh than they would have in Myanmar. Our findings regarding dowry are consistent with current literature, which describes generally lower expectations around dowry amounts, but that financial limitations still challenge the affordability of marriage for some girls\u0026rsquo; families. (38) \u003c/p\u003e\n\n\u003cp\u003eRohingya are prohibited by the Bangladeshi government from working due to their FDMN status, which makes livelihood and income-generating opportunities very rare within camp. Moreover, there is no formal system of schooling within the camp, and all educational opportunities are provided informally via NGOs or private tutors. Without these typical outlets, adolescents are left with few ways to demonstrate independence and to contribute to their community. Thus, in addition to the protection-related and financial incentives that marriage can provide, child marriage may also act as one of the only remaining markers or milestones to signify reaching adulthood for FDMN adolescents. \u003c/p\u003e\n\n\u003cp\u003eRestoring the social and economic opportunities that are typically available to adolescents in non-displaced settings (i.e. employment and education) would provide the best alternatives to marriage for adolescents (and particularly males), who are otherwise at home with little to do and little other way of establishing their transition into adulthood. Additionally, in our focus group discussions, participants often mentioned that they appreciated the opportunity to share with their peers and learn more about these topics. Though outside the scope of this paper, qualitative data on premarital knowledge did indicate that adolescents didn\u0026rsquo;t have many opportunities or spaces to discuss themes around child marriage and early childbearing prior to marriage. Thus, the creation of adolescent groups may be a useful compliment to the provision of educational and livelihood opportunities to more directly discuss and educate adolescents on topics of marriage and childbearing. Because of existing gender norms and taboos about adolescents not engaging in pre-marital relationships, separating these groups by gender would likely be critical for community acceptance. However, this would also give facilitators the unique chance to discuss the gender-specific ways that the conflict and displacement has affected both girls\u0026rsquo; and boys\u0026rsquo; experience of child marriage and early childbearing to prevent future early marriages. \u003c/p\u003e\n\n\u003cp\u003eMelnikas et al. and Islam et al. both identified religion as a notable factor underpinning early marriage and that the teachings of Islam directly mandate earlier marriage (particularly for girls at the onset of menarche) within the Rohingya community (37,38). Interestingly, the same could not be said for this study. While our interview guides did not specifically inquire about the role of religion, open-ended questions about drivers of early marriage within the Rohingya community rarely produced mention of religion, Islam, or related teachings. Moreover, as part of a participatory Venn diagraming activity, FGD participants were asked to categorize people and events into categories as having the \u0026ldquo;most influence\u0026rdquo;, \u0026ldquo;a lot of influence\u0026rdquo; or only \u0026ldquo;some\u0026rdquo; influence regarding decision-making around marriage age and timing within their community. FGD participants overwhelmingly put religious figures such as Imams and Majhees in the \u0026ldquo;some influence\u0026rdquo; category, and a couple focus groups did not mention religious leaders at all. While our findings do not necessarily contradict previous findings around religion, they do perhaps point to changing socioreligious norms, and/or more practical child marriage drivers becoming relatively more salient amongst the Rohingya community after experiencing more prolonged displacement within the camp setting. \u003c/p\u003e\n\n\u003cp\u003eWe found less evidence of ways in which displacement affected transitions into childbearing upon marriage. There was a strong cultural custom for near-immediate childbearing after marriage, regardless of the age of the spouses. The desire for immediate demonstration of fecundity after marriage was so strong that several participants communicated that, should a wife fail to conceive within a year or two of marriage, it was not uncommon for her husband to threaten to and/or enter into a second (polygamous) marriage to find a wife who increase his chances of having a child. This illustrates the pressure that young brides face to conceive early, in order to secure her marital relationship and avoid social stigma, which is reflected in qualitative data from numerous non-humanitarian studies (7,14) as well as one previous study conducted with Rohingya adolescents specifically (37). Social pressures to conceive thus seem to have been present prior to the conflict, indicating that this norm was largely unaffected by the displacement experience. This finding was reinforced by our quantitative findings, which demonstrated that there was no difference in time to childbirth after marriage between age cohorts or by age at marriage. \u003c/p\u003e\n\n\u003cp\u003eOther norms around fertility, and particularly those around subsequent childbearing, however, were strongly affected by displacement. Numerous respondents identified challenges of raising families within the constrained environments of camps and chose to practice family planning to better provide for the children they already have. Fertility norms thus seem to be affecting overall desires for number and timing of children \u003cem\u003eafter\u003c/em\u003e the first child is born and family connections have been cemented. Thus, continued programming about birth spacing, particularly targeted at younger adolescents, could serve as an entry point to discuss family planning. Adolescent sexual and reproductive health programs that promote delaying first births, however, are unlikely to be successful without broader community engagement to address the pervasive norms surrounding the importance of demonstrating fecundity immediately upon marriage. \u003c/p\u003e\n\n\u003cp\u003eOur study should be considered in light of several limitations. First, while we had hoped to exclusively recruit Rohingya data collectors for both male and female participants, only the male data collectors were Rohingya, and female data collectors were part of the host community. This was due to high levels of competition amongst IGOs and NGOs within the camps for female Rohingya volunteers, and limited availability. Despite our including topics such as cultural sensitivity and minimizing bias as part of the data collectors\u0026rsquo; training, it is possible that longstanding tension between Rohingya and host communities (33) limited the level of openness our female participants felt with their interviewers, potentially affecting the correctness and/or depth of their responses. Additionally, stigma around movement for young, and particularly unmarried girls/adolescents limited the amount of privacy that interviewers had when discussing these sensitive topics with adolescents in otherwise quite cramped living conditions. It is possible that adolescents answered the questions differently out of fear that another family member might hear their answers and disapprove of them. Despite these limitations, however, our study has many strengths. We recruited a diverse response pool, composed of both married and unmarried males and females. Previous research in Cox\u0026rsquo;s Bazaar was limited to married females (37), and thus lacked a comparative perspective, both in terms of marriage or gender. Very few studies have included males in studies of child marriage, despite their own risks for marriage and the influence they have on female partners. Additionally, we partnered with an established organization, that was already well-respected and trusted within the community. \u003c/p\u003e"},{"header":"CONCLUSION AND RECOMMENDATIONS ","content":"\u003cp\u003eConflict and displacement were found to have a varied effect on family formation among Rohingya adolescents, particularly across genders. Additionally, the camp context both exacerbated preexisting drivers of child marriage, as well as created new drivers. Most child marriage drivers discussed by our participants were practical considerations, rather than a deep-set belief in the moral or religious imperative to marry early. This is somewhat of a departure from the emphasis that previous literature has placed on the cultural norms underpinning child marriage, particularly for girls. Early childbearing seemed to be much less affected by conflict and displacement, but fertility rates have seemingly significantly reduced due to resource constraints within camp. \u003c/p\u003e\n\n\u003cp\u003eEfforts to improve adolescent sexual and reproductive health should be concentrated on restoring the educational and livelihood opportunities that both female and male adolescents have lost due to conflict, displacement, and living in a camp setting. The feeling of having no other options, pushes adolescents, and especially males and their families, towards pursuing child marriage and subsequent early childbearing. The Bangladeshi government must ease restrictions on availability of education and income-generating opportunities for FDMNs, as both would provide adolescents and their families with alternative options that would allow them to transition into adulthood and to contribute to their community outside of child marriage. \u003c/p\u003e\n\n\u003cp\u003eAdditionally, our participants, both married and unmarried, expressed a desire to have spaces like our focus group discussions where they can discuss these topics. Current programs geared towards child marriage and early childbearing are primarily, if not exclusively, focused on prevention \u0026ndash; which leaves the population of already-married adolescents very few resources and outlets for support regarding their health and wellness within the marriage. Creating spaces for adolescents to gather may also provide an opportunity to discuss marriage and childbearing, generally considered \u0026ldquo;taboo\u0026rdquo; prior to marriage. These venues would also be opportunities to continue providing education around family planning and healthy birth spacing. Practitioners must work with the community leaders, like Majhees or the CIC, who regularly interact with recently-married adolescents to encourage participation in health workshops early on in marriage, when couples are beginning to establish their families.\u003c/p\u003e\n\n\u003cp\u003eAddressing many of the restrictive gender norms that promote child marriage and childbearing, such as the need for females to conduct gendered housework and to prove fecundity upon marriage, require broader community engagement. Parents and community leaders must also be engaged in order to identify and challenge some of the most pervasive gender norms. This may be particularly important when addressing norms around early childbearing, which appear to be particularly persistent and little affected by conflict. \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCIC Camp-in-Charge\u003c/p\u003e\n\u003cp\u003eCPI Community Partners International\u003c/p\u003e\n\u003cp\u003eBRAC-JPG BRAC James P Grant School of Public Health\u003c/p\u003e\n\u003cp\u003eFDMN Forcibly-Displaced Myanmar Nationals\u003c/p\u003e\n\u003cp\u003eFGD Focus Group Discussions \u003c/p\u003e\n\u003cp\u003eIDI In-depth Interviews \u003c/p\u003e\n\u003cp\u003eIGO Intergovernmental Organization\u003c/p\u003e\n\u003cp\u003eKII Key Informant Interviews\u003c/p\u003e\n\u003cp\u003eNGO Non-governmental Organizations\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate.\u003c/strong\u003e Ethical approval was provided by both The Johns Hopkins Bloomberg School of Public Health Institutional Review Board (FWA00000287) and BRAC James P Grant School of Public Health, BRAC University\u0026rsquo;s review board (IRB protocol no.: IRB-25 June\u0026rsquo;22-022). Due to widespread illiteracy and as Rohingya is not a written language, all participants provided verbal consent to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication.\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials.\u0026nbsp;\u003c/strong\u003eThe qualitative datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests.\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u0026nbsp;\u003c/strong\u003e Elrha R2HC (Research for Health in Humanitarian Crises) provided the funding for this study.\u0026nbsp;The R2HC program is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome Trust, and the Department of Health and Social Care (DHSC) through the National Institute for Health Research (NIHR).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions.\u0026nbsp;\u003c/strong\u003eKM contributed to the study design, designed study materials, supported data collection, analyzed the data, and wrote the manuscript. Tahia H contributed to study design, organized and conducted data collection, supported data analysis, and edited the manuscript. AC was a significant contributor to drafting and editing the Background section. KL supported data analysis and edited the manuscript. MB supported data analysis and edited the manuscript. Tanvir H contributed to study design, supported data collection and data analysis, and edited the manuscript. SE contributed to the study design, designed study materials, supported data collection, analyzed the quantitative data, and edited the manuscript. WCR designed the study, supported data collection and data analysis, and coordinated submission of IRB applications. LAZ designed the study and study materials, supported data collection and data analysis, coordinated submission of IRB applications, and was a major contributor to manuscript drafting and editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements.\u0026nbsp;\u003c/strong\u003eThe\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eauthors would like to first thank the Rohingya participants and communities within Cox\u0026rsquo;s Bazar who generously shared their time and experiences, thus making this study possible. The authors would also like to thank the members of the community advisory board, whose expertise allowed for more culturally sensitive and relevant interview guides and study implementation. The authors would also like to thank the many data collectors who carefully recruited, consented, interviewed the study participants. Finally, the authors would also like to thank CPI for their acting as a community liaison and providing space for trainings and data collection activities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHassfurter K. Child Protection from Violence, Exploitation and Abuse [Internet]. UNICEF; 2011 Mar [cited 2024 May 9]. Available from: https://data.unicef.org/resources/child-protection-violence-exploitation-abuse/\u003c/li\u003e\n\u003cli\u003eUnited Nations. Universal Declaration of Human Rights [Internet]. United Nations; Dec 10, 1948. Available from: https://www.un.org/en/about-us/universal-declaration-of-human-rights\u003c/li\u003e\n\u003cli\u003eUNICEF. Convention on the Rights of the Child [Internet]. 1989. Available from: https://www.unicef.org/child-rights-convention\u003c/li\u003e\n\u003cli\u003eArthur M, Earle A, Raub A, Vincent I, Atabay E, Latz I, et al. Child Marriage Laws around the World: Minimum Marriage Age, Legal Exceptions, and Gender Disparities. Journal of Women, Politics \u0026amp; Policy. 2018 Jan 2;39(1):51\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eUNICEF. UNICEF DATA. 2023 [cited 2024 May 9]. Child marriage. Available from: https://data.unicef.org/topic/child-protection/child-marriage/\u003c/li\u003e\n\u003cli\u003eRaj A. When the mother is a child: the impact of child marriage on the health and human rights of girls. Arch Dis Child. 2010 Nov;95(11):931\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eMiller FA, Dulal S, Rai A, Gram L, Harris-Fry H, Saville NM. \u0026ldquo;Can\u0026rsquo;t live willingly\u0026rdquo;: A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia. PLOS Global Public Health. 2023 Oct 23;3(10):e0002279. \u003c/li\u003e\n\u003cli\u003eErulkar A. Adolescence lost: the realities of child marriage. J Adolesc Health. 2013 May;52(5):513\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eBillah MA, Khan MdMA, Hanifi SMA, Islam MM, Khan MdN. Spatial pattern and influential factors for early marriage: evidence from Bangladesh Demographic Health Survey 2017-18 data. BMC Women\u0026rsquo;s Health. 2023 Jun 20;23(1):320. \u003c/li\u003e\n\u003cli\u003eMisunas C, Gast\u0026oacute;n CM, Cappa C. Child marriage among boys in high-prevalence countries: an analysis of sexual and reproductive health outcomes. BMC International Health and Human Rights. 2019 Aug 16;19(1):25. \u003c/li\u003e\n\u003cli\u003eLee-Rife S, Malhotra A, Warner A, Glinski AM. What works to prevent child marriage: a review of the evidence. Stud Fam Plann. 2012 Dec;43(4):287\u0026ndash;303. \u003c/li\u003e\n\u003cli\u003eUNFPA. Marrying too Young [Internet]. UNFPA; 2012 Jan [cited 2024 May 9]. Available from: https://www.unfpa.org/publications/marrying-too-young\u003c/li\u003e\n\u003cli\u003eIbarra-Nava I, Choudhry V, Agardh A. Desire to delay the first childbirth among young, married women in India: a cross-sectional study based on national survey data. BMC Public Health. 2020 Mar 18;20(1):350. \u003c/li\u003e\n\u003cli\u003eScott S, Nguyen PH, Neupane S, Pramanik P, Nanda P, Bhutta ZA, et al. Early marriage and early childbearing in South Asia: trends, inequalities, and drivers from 2005 to 2018. Ann N Y Acad Sci. 2021 May;1491(1):60\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eMarphatia AA, Ambale GS, Reid AM. Women\u0026rsquo;s Marriage Age Matters for Public Health: A Review of the Broader Health and Social Implications in South Asia. Front Public Health. 2017;5:269. \u003c/li\u003e\n\u003cli\u003eFan S, Koski A. The health consequences of child marriage: a systematic review of the evidence. BMC Public Health. 2022 Feb 14;22(1):309. \u003c/li\u003e\n\u003cli\u003ePsaki SR, Melnikas AJ, Haque E, Saul G, Misunas C, Patel SK, et al. What Are the Drivers of Child Marriage? A Conceptual Framework to Guide Policies and Programs. J Adolesc Health. 2021 Dec;69(6S):S13\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eKrafft C, Arango DJ, Rubin AH, Kelly J. Conflict and Girl Child Marriage: Global Evidence [Internet]. The World Bank; 2022 [cited 2024 May 24]. (Policy Research Working Papers). Available from: http://elibrary.worldbank.org/doi/book/10.1596/1813-9450-10135\u003c/li\u003e\n\u003cli\u003eHunersen K, Attal B, Jeffery A, Metzler J, Alkibsi T, Elnakib S, et al. Child Marriage in Yemen: A Mixed Methods Study in Ongoing Conflict and Displacement. Journal of Refugee Studies. 2021 Dec 1;34(4):4551\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eUNFPA, UNICEF. Addressing Child Marriage in Humanitarian Settings: Technical Guide for Staff and Partners of the UNFPA\u0026ndash;UNICEF Global Programme to End Child Marriage [Internet]. New York, NY; [cited 2024 May 24]. Available from: https://www.unfpa.org/resources/addressing-child-marriage-humanitarian-settings-technical-guide-staff-and-partners-unfpa\u003c/li\u003e\n\u003cli\u003eElnakib S, Hussein SA, Hafez S, Elsallab M, Hunersen K, Metzler J, et al. Drivers and consequences of child marriage in a context of protracted displacement: a qualitative study among Syrian refugees in Egypt. BMC Public Health. 2021 Apr 7;21(1):674. \u003c/li\u003e\n\u003cli\u003eHutchinson A, Waterhouse P, March-McDonald J, Neal S, Ingham R. Understanding Early Marriage and Transactional Sex In the Context of Armed Conflict: Protection at a Price. Int Perspect Sex Reprod Health. 2016 Mar 1;42(1):45\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eTzemach Lemmon G. Fragile States, Fragile Lives: Child Marriage Amid Disaster and Conflict [Internet]. Council on Foreign Relations. 2014 [cited 2024 May 9]. Available from: https://www.cfr.org/blog/fragile-states-fragile-lives-child-marriage-amid-disaster-and-conflict\u003c/li\u003e\n\u003cli\u003eKnox SE. How they see it: young women\u0026rsquo;s views on early marriage in a post-conflict setting. Reproductive Health Matters. 2017 Oct 27;25(sup1):96\u0026ndash;106. \u003c/li\u003e\n\u003cli\u003eElnakib S, Paina L, Attal B, Akter R, Khoury G, Karim L, et al. Incidence of child marriage among refugees and internally displaced persons in the Middle East and South Asia: evidence from six cross-sectional surveys. BMJ Open. 2023 Jun 15;13(6):e070056. \u003c/li\u003e\n\u003cli\u003eNeal S, Stone N, Ingham R. The impact of armed conflict on adolescent transitions: a systematic review of quantitative research on age of sexual debut, first marriage and first birth in young women under the age of 20 years. BMC Public Health. 2016 Mar 4;16(1):225. \u003c/li\u003e\n\u003cli\u003eSamandari G, Sarker BK, Grant C, Huq NL, Talukder A, Mahfuz SN, et al. Understanding individual, family and community perspectives on delaying early birth among adolescent girls: findings from a formative evaluation in rural Bangladesh. BMC Women\u0026rsquo;s Health. 2020 Aug 10;20(1):169. \u003c/li\u003e\n\u003cli\u003eThiede BC, Hancock M, Kodouda A, Piazza J. Exposure to Armed Conflict and Fertility in Sub-Saharan Africa. Demography. 2020 Oct 16;57(6):2113\u0026ndash;41. \u003c/li\u003e\n\u003cli\u003eCastro Torres AF, Urdinola BP. Armed Conflict and Fertility in Colombia, 2000\u0026ndash;2010. Popul Res Policy Rev. 2019 Apr 1;38(2):173\u0026ndash;213. \u003c/li\u003e\n\u003cli\u003eWoldemicael G. Recent fertility decline in Eritrea: Is it a conflict-led transition? Demographic Research. 2008;18:27\u0026ndash;58. \u003c/li\u003e\n\u003cli\u003eMourtada R, Melnikas AJ. Crisis upon crisis: a qualitative study exploring the joint effect of the political, economic, and pandemic challenges in Lebanon on Syrian refugee women\u0026rsquo;s fertility preferences and behaviour. Confl Health. 2022 Jun 15;16(1):35. \u003c/li\u003e\n\u003cli\u003eHawkey AJ, Ussher JM, Perz J. \u0026ldquo;If You Don\u0026rsquo;t Have a Baby, You Can\u0026rsquo;t Be in Our Culture\u0026rdquo;: Migrant and Refugee Women\u0026rsquo;s Experiences and Constructions of Fertility and Fertility Control. Women\u0026rsquo;s Reproductive Health. 2018 Apr 3;5(2):75\u0026ndash;98. \u003c/li\u003e\n\u003cli\u003eUNHCR. Bangladesh: Analysis of Gaps in the Protection of Rohingya Refugees [Internet]. 2007 May [cited 2024 May 9]. Available from: https://www.unhcr.org/us/media/bangladesh-analysis-gaps-protection-rohingya-refugees-may-2007\u003c/li\u003e\n\u003cli\u003eUNFPA. Cox\u0026rsquo;s Bazar: A displaced people longing for a sense of home [Internet]. [cited 2024 May 9]. Available from: https://www.unfpa.org/coxs-bazar-bangladesh\u003c/li\u003e\n\u003cli\u003eMahmood SS, Wroe E, Fuller A, Leaning J. The Rohingya people of Myanmar: health, human rights, and identity. Lancet. 2017 May 6;389(10081):1841\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eUNFPA Asia Pacific Regional Office, UNICEF Regional Office for South Asia. Child Marriage in Humanitarian Settings in South Asia [Internet]. 2020 Oct [cited 2024 May 9]. Available from: https://asiapacific.unfpa.org/en/publications/child-marriage-humanitarian-settings-south-asia\u003c/li\u003e\n\u003cli\u003eIslam MM, Khan MN, Rahman MM. Factors affecting child marriage and contraceptive use among Rohingya girls in refugee camps. Lancet Reg Health West Pac. 2021 Jul;12:100175. \u003c/li\u003e\n\u003cli\u003eMelnikas AJ, Ainul S, Ehsan I, Haque E, Amin S. Child marriage practices among the Rohingya in Bangladesh. Conflict and Health. 2020 May 25;14(1):28. \u003c/li\u003e\n\u003cli\u003ePlan International. Plan International. [cited 2024 May 9]. Child marriage in Bangladesh. Available from: https://plan-international.org/publications/child-marriage-in-bangladesh/\u003c/li\u003e\n\u003cli\u003eAkter S, Williams C, Talukder A, Islam MN, Escallon JV, Sultana T, et al. Harmful practices prevail despite legal knowledge: a mixed-method study on the paradox of child marriage in Bangladesh. Sex Reprod Health Matters. 2021;29(2):1885790. \u003c/li\u003e\n\u003cli\u003eAl Akash R, Boswall K. Listening to the Voices of Syrian Women Refugees in Jordan: Ethnographies of Displacement and Emplacement. In: Aksaz E, P\u0026eacute;rouse JF, editors. \u0026ldquo;Guests and Aliens\u0026rdquo;: Re-Configuring New Mobilities in the Eastern Mediterranean After 2011 - with a special focus on Syrian refugees [Internet]. İstanbul: Institut fran\u0026ccedil;ais d\u0026rsquo;\u0026eacute;tudes anatoliennes; 2016 [cited 2024 Aug 12]. Available from: https://books.openedition.org/ifeagd/1884\u003c/li\u003e\n\u003cli\u003eOrtiz-Echevarria L, Greeley M, Bawoke T, Zimmerman L, Robinson C, Schlecht J. Understanding the unique experiences, perspectives and sexual and reproductive health needs of very young adolescents: Somali refugees in Ethiopia. Confl Health. 2017 Nov;11(S1):26. \u003c/li\u003e\n\u003cli\u003eDeJong J, Sbeity F, Schlecht J, Harfouche M, Yamout R, Fouad FM, et al. Young lives disrupted: gender and well-being among adolescent Syrian refugees in Lebanon. Confl Health. 2017 Nov;11(S1):23. \u003c/li\u003e\n\u003cli\u003eDanjibo N, Akinkuotu A. Rape as a weapon of war against women and girls. Gender and Behaviour. 2019 Jul 5;17(2):13161\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eSeth K, Nanda S, Sahay A, Verma R, Achyut P. Men, The Missing Link In Gender-equitable Family Planning: A Scoping Review. Gates Open Res. 2022 Jun 22;6:73. \u003c/li\u003e\n\u003cli\u003eRazzaque A. Preference for Children and Subsequent Fertility in Matlab: Does Wife-Husband Agreement Matter? Journal of Biosocial Science. 1999 Jan;31(1):17\u0026ndash;28. \u003c/li\u003e\n\u003cli\u003eShahabuddin ASM, N\u0026ouml;stlinger C, Delvaux T, Sarker M, Bardaj\u0026iacute; A, Brouwere VD, et al. What Influences Adolescent Girls\u0026rsquo; Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh. PLOS ONE. 2016 Jun 23;11(6):e0157664. \u003c/li\u003e\n\u003cli\u003eGuglielmi S, Seager, Jennifer, Mitu, Khadija, Jones, Nicola, Baird, Sarah. The Lives They Lead: Exploring the Capabilities of Bangladeshi and Rohingya Adolescents in Cox\u0026rsquo;s Bazar, Bangladesh | IPA [Internet]. [cited 2024 May 9]. Available from: https://poverty-action.org/publication/lives-they-lead-exploring-capabilities-bangladeshi-and-rohingya-adolescents-cox%E2%80%99s-bazar\u003c/li\u003e\n\u003cli\u003eMitu K, Jones N, Vintges J, Devonald M. Climate Risks and Truncated Opportunities: How Do Environmental Challenges Intersect with Economic and Social Disadvantages for Rohingya Adolescents in Bangladesh? Sustainability. 2022 Jan;14(8):4466. \u003c/li\u003e\n\u003cli\u003eShohel MMC. Education in emergencies: challenges of providing education for Rohingya children living in refugee camps in Bangladesh. Education Inquiry. 2022 Jan 2;13(1):104\u0026ndash;26. \u003c/li\u003e\n\u003cli\u003eRahman MdM, Shindaini AJM, Husain T. Structural barriers to providing basic education to Rohingya children in the Kutupalong refugee camp, Cox\u0026rsquo;s Bazar, Bangladesh. International Journal of Educational Research Open. 2022;3:100159. \u003c/li\u003e\n\u003cli\u003eBartels SA, Michael S, Roupetz S, Garbern S, Kilzar L, Bergquist H, et al. Making sense of child, early and forced marriage among Syrian refugee girls: a mixed methods study in Lebanon. BMJ Glob Health. 2018;3(1):e000509. \u003c/li\u003e\n\u003cli\u003eAinul S, Ehsan I, Haque E, Amin S, Rob U, Melnikas A, et al. Marriage and sexual and reproductive health of Rohingya adolescents and youth in Bangladesh: A qualitative study. Poverty, Gender, and Youth [Internet]. 2018 Jan 1; Available from: https://knowledgecommons.popcouncil.org/departments_sbsr-pgy/460\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Individuals married prior to age 18 are automatically considered emancipated minors, due to their marital status.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e \u003cspan\u003e Participants often used \u0026ldquo;Burma\u0026rdquo; to refer to their home country, as the difference between using \u0026ldquo;Burma\u0026rdquo; vs \u0026ldquo;Myanmar\u0026rdquo; is more distinct in English.\u003c/span\u003e \u003c/li\u003e\u003cli\u003e\u003cspan\u003e \u0026ldquo;Eve teasing\u0026rdquo; refers to the act of males making unwanted sexual remarks or advances towards a female in a public space.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u003cem\u003eNote: participants did occasionally discuss the merits of marriage and childbearing from a religious or moral perspective generally, but not with regard to child marriage or early childbearing specifically.\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"conflict-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"conf","sideBox":"Learn more about [Conflict and Health](http://conflictandhealth.biomedcentral.com/)","snPcode":"13031","submissionUrl":"https://submission.nature.com/new-submission/13031/3","title":"Conflict and Health","twitterHandle":"@Conflict_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Family formation, early marriage, child marriage, childbearing, fertility, fecundity, humanitarian settings, Cox’s Bazar, Rohingya, Forcibly-displaced Myanmar Nationals, conflict, displacement, adolescent health","lastPublishedDoi":"10.21203/rs.3.rs-4952569/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4952569/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground. \u003c/strong\u003eHumanitarian\u003cstrong\u003e \u003c/strong\u003eemergencies are postulated to increase rates of early marriage and early childbearing, as drivers of both are heightened or exacerbated in crisis settings. There is a critical need for research that explores the causal mechanisms that motivate family formation, i.e. the process from marriage into childbearing, and how this process is affected by conflict and displacement.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective.\u003c/strong\u003e This paper aims to describe how displacement and living within a camp context has affected trends, norms, and drivers around family formation, focusing on the lived experience of female and male adolescents and young adults aged 15-24.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods. \u003c/strong\u003eWe coded and analyzed qualitative data\u003cstrong\u003e \u003c/strong\u003efrom forty-nine in-depth interviews and sixteen focus group discussions conducted with Forcibly Displaced Myanmar Nationals aged 15-24 who arrived in Cox’s Bazar during or after October 2016.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults. \u003c/strong\u003eParticipants agreed that rates of child marriage have increased post-conflict and displacement and generally attributed this increase to a variety of drivers, including fears around protection, socioeconomic need, lack of education and/or employment opportunities, and a perceived loosening of restrictions around legal age of marriage within camp. While some of these are pre-existing drivers exacerbated by conflict and displacement, others are new drivers that have developed as a result. The ways that adolescents experienced each driver were also highly gendered. Conversely, conflict and displacement had seemingly little effect on cultural expectations to demonstrate fecundity immediately after marriage. Finally, participants felt that adverse living conditions within camp have significantly lowered fertility intentions and have increased adoption of family planning.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions. \u003c/strong\u003eOur results demonstrate that many Rohingya families currently view child marriage more as a practical tool to overcome challenges associated with being displaced, and early childbearing as an inevitable natural consequence of child marriage. The Bangladeshi government must ease restrictions on educational and livelihood opportunities for both adolescent girls and boys, who otherwise have no alternatives to child marriage, and few other opportunities to thrive and productively contribute to their communities.\u003c/p\u003e","manuscriptTitle":" “What other option did I have?” – The effect of conflict and displacement on child marriage and early childbearing among displaced Rohingya adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-03 10:25:32","doi":"10.21203/rs.3.rs-4952569/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-01T02:44:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-29T15:55:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-14T10:15:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29668043681793520387966511391057484769","date":"2024-09-09T12:48:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318448098750908601589006062030341560289","date":"2024-09-08T04:17:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-07T18:13:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-02T10:11:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-02T10:08:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Conflict and Health","date":"2024-08-21T15:06:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"conflict-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"conf","sideBox":"Learn more about [Conflict and Health](http://conflictandhealth.biomedcentral.com/)","snPcode":"13031","submissionUrl":"https://submission.nature.com/new-submission/13031/3","title":"Conflict and Health","twitterHandle":"@Conflict_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c0becae3-3255-46d2-b34e-05ac9ad527c0","owner":[],"postedDate":"October 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-24T16:02:29+00:00","versionOfRecord":{"articleIdentity":"rs-4952569","link":"https://doi.org/10.1186/s13031-025-00656-2","journal":{"identity":"conflict-and-health","isVorOnly":false,"title":"Conflict and Health"},"publishedOn":"2025-03-17 15:57:48","publishedOnDateReadable":"March 17th, 2025"},"versionCreatedAt":"2024-10-03 10:25:32","video":"","vorDoi":"10.1186/s13031-025-00656-2","vorDoiUrl":"https://doi.org/10.1186/s13031-025-00656-2","workflowStages":[]},"version":"v1","identity":"rs-4952569","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4952569","identity":"rs-4952569","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}