Consent and Conflict: Factors Associated with Premarital Decision-Making for Young Women in Conflict-Affected Settings in Yemen

Consent and Conflict: Factors Associated with Premarital Decision-Making for Young Women in Conflict-Affected Settings in Yemen | 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 Consent and Conflict: Factors Associated with Premarital Decision-Making for Young Women in Conflict-Affected Settings in Yemen Charlotte Greenbaum, Huda Tauseef, Tareq Alkebsi, Aisha AlDaram, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6762440/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background . Although the rate of child, early, and forced marriage (CEFM) has decreased over the last decade, one in five girls globally will still be married before age 18. While research has identified drivers of child marriage, less attention has been paid to understanding the involvement of young women themselves in the process of marriage, including their decision-making and potential motivations to marry when living in humanitarian settings characterized by poverty and limited opportunities. This study uses quantitative and qualitative data to explore factors associated with perceived involvement in decision-making at time of first marriage among young women in Yemen. Methods . The data for this study come from the Early Marriage Early Childbearing (EMEC) study, which was conducted in 2022 in the governorates of Aden, Hadramout, and Ma’arib. This analysis uses data from 991 quantitative surveys and 47 in-depth interviews with married young women. We use logistic regression to examine the association between child marriage and autonomy in decision-making around marriage. We then conduct thematic analysis of in-depth interviews to examine decision-making processes and motivations in marriage. Results . Among the 991 ever-married female respondents, approximately 55% were married before 18 years of age and half had been displaced. After controlling for covariates, child marriage and displacement status were significantly associated with reduced involvement in marital decision-making. Child brides had 85% greater odds of reporting little or no involvement in the decision to marry than did those married at age 18 or older, and displaced young women had 36% greater odds than did those not displaced. Qualitative data illustrate the significant familial and social pressures that girls and young women face to accept proposals and the diverse understandings of what marriage readiness entails. Conclusions . We find that young women report a relatively high level of decision-making surrounding marriage, although involvement was significantly lower for those who married before age 18 and for those displaced. The qualitative data highlight that despite such reported involvement, girls live within contexts of limited choice, including norms that support child marriage, lack of educational or labor opportunities, and challenging conditions in the home. Child marriage Marriage decision-making Agency Conflict Humanitarian settings Adolescent health Middle East Yemen Sexual and reproductive health Background Although the rate of child, early, and forced marriage (CEFM) has decreased over the last decade, one in five girls globally will still be married before age 18.( 1 ) By 2030, an additional 150 million girls will be married.( 2 ) In Yemen, the latest Multiple Indicator Cluster Survey from 2022-23 estimated that approximately 30% of young women aged 20–24 years were married by age 18.( 3 ) Other recent research found similar estimates with higher rates of marriage by age 18 among ever-displaced and never-displaced women.( 4 ) While the pathways involved in child marriage and the role of premarital factors remain unclear, child marriage increases the risk for several adverse health outcomes and conditions, including increased risk of maternal and neonatal health complications, sexually transmitted infections, depression, malaria, and cervical cancer.( 1 , 5 , 6 ) Girls who marry before they turn 18 are also less likely to remain in school, less likely to receive antenatal care, and more likely to experience intimate partner violence, potentially excluding them from participating in their communities and damaging their physical and psychological well-being.( 1 , 6 – 9 ) The drivers of child marriage vary greatly across settings, but researchers have identified multiple factors, including social norms and attitudes, particularly gender norms that serve to stigmatize young women’s sexuality and reinforce traditional roles for women such as mothers, wives, and caretakers. These factors are frequently exacerbated by poverty and/or lack of economic and education opportunities.( 10 – 13 ) Evidence suggests that in periods of conflict and instability, these underlying drivers may be amplified, resulting in higher rates of child marriage. Indeed, seven out of ten countries with the highest rates of child marriage were considered fragile states in 2017 and six of these countries were experiencing armed conflict and/or hosting conflict-displaced populations.( 2 ) Fear of real or perceived threats of increased violence,( 2 , 7 ) economic instability triggered by crisis-related displacement,( 14 ) and a lack of education opportunities as an alternative to marriage due to disruptions in educational systems( 15 ) may all drive increased child marriage. A lack of parental awareness of the potential negative consequences of child marriage may also contribute to higher rates, coupled with a severe lack of support and competing priorities to ensure health and safety.( 16 ) However, gaps remain in understanding how context-specific factors affect child marriage and the marriage decision-making process in humanitarian settings.( 17 ) In Yemen, Girls Not Brides identifies poverty, limited education, family honor, COVID-19-related disruptions, and vulnerabilities related to the ongoing humanitarian crisis as drivers of child marriage in the country.( 18 ) Recent research by coauthors, conducted under the same project as the current study, has also revealed that not having attended school and having an unemployed female adult in the household are associated with an increased risk of child marriage in Yemen. Economic factors are often cited in decision-making around entering marriage as well.( 19 ) While research has identified these drivers, less attention has been given to understanding the involvement of young women themselves in the process of child marriage, including their decision-making and potential motivations to marry when living in situations characterized by poverty and a lack of opportunity. Although autonomy and choice are factors closely tied to overall health and well-being, they have been frequently neglected in research on child marriage.( 20 ) Research in Egypt found an association between age at marriage and measures of agency, but this relationship was not significant after accounting for premarital factors.( 21 ) The current literature links reduced autonomy within marriage to worse health outcomes, such as worse maternal health outcomes and lower use of contraception,( 15 , 22 – 24 ) but few studies address autonomy with respect to the decision to marry. While child marriage is understood in the global community as a strict violation of human rights and thus a practice that requires elimination, research has rarely explored the exercise of agency among young women in matters related to their marriage or reasons why such women may express a preference toward marriage.( 25 ) For example, prevailing narratives around child marriage in the literature depict young women as lacking agency in the choice to marry; however, some studies have revealed that they can exercise agency to pursue marriage in situations where they lack alternative options.( 25 ) The few studies that explore the role of agency in crisis settings offer a complex story. Families frequently state that young women are given a choice to refuse suiters and assert their preferences; however, young women explain that family elders have considerable influence over their decision.( 14 ) This influence, combined with young women’s perceptions that child marriage is a norm in their communities, results in very few young women admitting that they are forced into their marriage. Instead, many believe that they are ready for marriage and that the decision is their own.( 14 , 15 ) To address the current research gaps in the understanding of autonomy in decision-making around marriage, particularly in situations of conflict, this research uses quantitative and qualitative data to explore factors associated with perceived involvement in decision-making at time of first marriage among young women in Yemen. Specifically, we examine the associations between perceived involvement in the decision to marry, one’s age at marriage, and one’s displacement status using quantitative survey data from a sample of displaced and nondisplaced young women residing in Yemen. We then use qualitative data collected through in-depth interviews with married young women to contextualize these findings and center the voices of young women in explaining decisions surrounding marriage. Methods Study Setting For nine years, Yemen has been in a conflict described as the worst humanitarian crisis in the world by the United Nations.(26) In 2014, civil war broke out in the country between Houthi forces and President Abd Rabbu Mansur Hadi’s government. Saudia Arabia, backed by US intelligence, led a counteroffensive attack via an economic embargo and airstrikes after the government was overthrown and left citizens trapped and living in famine conditions. According to the United Nations and the World Bank, in 2021, nearly 24 million people, or 80% of the population, were in need of humanitarian protection and aid, or were at risk for hunger and disease. Prior to this conflict, Yemen was already the poorest country in the region, and since 2014, this crisis has compounded already severe challenges to the education, water and sanitation, and healthcare systems.(16,26,27) In this context, the current study focused on three governorates in Yemen representing three of the five governorates with the largest number of internally displaced persons: Aden, Hadramout, and Ma’arib.(28) These governorates were purposively selected based on the feasibility of data collection and the large number of displaced individuals. Aden, the capital of the internationally recognized government, has experienced relative stability compared with other parts of Yemen, making it a feasible location for data collection despite ongoing humanitarian needs and displacement flows. Hadramout has remained comparatively secure throughout the conflict, serving as a destination for displaced populations from more conflict-affected regions. Ma’rib hass been actively affected by active conflict and hosts one of the highest concentrations of internally displaced persons (IDPs) in the country. Data The data for this study come from the Research for Health in Humanitarian Crises (R2HC)-funded Early Marriage Early Childbearing (EMEC) study, conducted in 2022 in the most densely populated districts of the governorates of Aden, Hadramout, and Ma’arib. This analysis uses data from both the quantitative adolescent survey and the in-depth interviews with married young women. Quantitative methods Sample Districts within each governorate were selected using different approaches due to ongoing safety and security concerns at the time of data collection. In Aden, districts were selected with probability proportional to the size of the district. In Hadramaut, given the large number and geographic dispersion of districts, six districts with sizeable IDP populations (over 2000 + IDPs residing in the district) were purposively selected. Finally, in Ma’arib, only two districts that were under the jurisdiction of the Aden government were selected. Zones, which served as clusters, were then selected across districts, again differing across governorate due to safety concerns. In Aden, 20 zones were selected with probability proportional to size. A total of 20 zones of 20 households (10 IDPs and 10 hosts) each were selected in each district. In Hadramout, which lacked zone-level data, community guides identified zones/areas with a comparatively higher concentration of IDPs. These zones served as our clusters. Twenty zones were selected in each district. In Ma’arib, 15 zones and 40 subzones were selected using probability proportional to size. The subzones served as the cluster. In each cluster, a random start was selected using the “spin the pen approach”; data collectors started at a random landmark and spun a pen to randomly select a direction. They then went to the nearest household in that direction and screened it for eligibility. Eligibility was defined as having at least one young woman between the ages of 15 and 24 who had lived in the household for at least one month. The next household was selected using the same method and the process continued until the sample size was reached in each zone. A total sample size of 1600 households was calculated with the goal of ensuring precision of prevalence estimates. The 1600 households were disproportionately allocated across the three governorates. Participants were oversampled in Ma’arib given the large number of IDPs. In total, we selected 400 IDPs and hosts in Aden, 400 IDPs and hosts in Hadramaut, and 800 IDPs and hosts in Ma’arib. For the purpose of the interviews, IDPs were self-identified as displaced due to the conflict. Hosts were defined as those living in close proximity to the IDPs included in the study. Data collection was carried out using two survey instruments: a brief household questionnaire, answered by an adult female, and a questionnaire on child marriage and childbearing that was administered to one to two young women aged 15–24 per household. If there were one or two adolescents in the household, both were eligible to respond; if there were more than two, two were randomly selected. Outcomes of interest Our primary outcome variable of interest assessed autonomy and involvement in decision-making in one’s first marriage using the following question in the survey: “How much were you involved in the decision to get married the FIRST time?”. Respondents could answer “completely”, “very much”, “not very much”, or “not at all”. This question was recoded as a binary variable consisting of “involved” (completely/very much”) and “not involved” (not very much/not at all). As decision-making for a second marriage would likely involve different actors and processes than those for the first, for the 20 women who had been married more than once we used information only on perceived decision-making involvement of their first marriage. Independent Variable As our primary question of interest assessed whether decision-making differed by age at marriage, our main independent variable of interest was a binary response to capture the experience of child marriage, defined as whether the young woman was less than 18 at the time of her first marriage. Young women married for the first time before 18 years of age were coded as child brides, while those married for the first time at 18 years of age or older were coded as nonchild brides. Our second question of interest was whether autonomy varied by displacement status. Displacement status was self-reported based on whether respondents reported being displaced from their location of origin due to conflict. Adolescents who reported that they had moved from their place of origin for reasons other than conflict were not considered displaced. Covariates We included additional covariates that we hypothesized could confound the relationship between age at marriage and marriage decision-making, based on previous literature. These include level of education and economic status of the household of origin.(29) Education was included as a continuous variable of the number of years of schooling the respondent had completed. Household economic status was a self-reported scale, wherein respondents were asked if they would categorize the economic status of their household of origin as very rich, rich, comfortable, or poor. This measure was condensed to a binary variable, comparing those who were comfortable, rich, or very rich to those who identified as poor. Owing to the significant correlation between displacement status and region, we did not include region as our primary objective was to isolate the effect of displacement. All analyses were conducted using STATA Version 18.1. Analytic Sample A total of 1,773 young women responded to the adolescent survey. Of those 1,733 respondents, 998 were currently or previously married and thus answered the marriage decision-making question. After accounting for missing data from other covariates of interest, the final analytical sample consisted of 991 young women. Statistical analysis Descriptive analysis was initially used to explore the data and ascertain the distribution of and variation across variables of interest. Thereafter, unadjusted and adjusted binary logistic regression models were employed to estimate odds ratios and 95% confidence intervals for associations between involvement in the decision to marry (reference group denoted lack of involvement and was coded as 0) and age at first marriage. Qualitative methods Qualitative data collected in this study include in-depth interviews with married young women and key informant interviews with community leaders, religious leaders, humanitarian actors, and service providers. For this analysis, we used data collected through in-depth interviews (IDIs) among 47 married young women. The participants in the IDIs were purposively selected, referred by other study participants, or identified during the conduct of the survey. All interviews were transcribed and translated into English and coded upon completion. The interview transcripts were analyzed using latent content analysis methods. The research team coded all transcripts using Dedoose, creating and refining codebooks using both inductive codes developed from previous research and deductive codes that emerged during analysis. Analysts met weekly during the coding phase to engage in memo-writing, reflexivity exercises, discuss emergent themes for additional codes, and identify any issues of inconsistencies with coding and/or the codebook. Once all transcripts were coded, summaries of the themes emerging within and across codes were developed. For this study, codes related to marriage decisionmakers, perceptions of marriage, motivations behind marriage, and the impact of conflict and displacement on marriage were extracted from the already coded transcripts. Within each code, excepts were analyzed to look for differences in emerging themes by age at marriage (before or after 18) and displacement status. Results Quantitative Respondent characteristics are shown in Table 1 below. Of the 991 respondents who were ever married, about 55% were married before 18 years of age. Of note, 10% of young women were married before age 15 (not shown). As expected, given our quota sampling, approximately half of the survey population was displaced (53% displaced versus 47% not displaced). On average, participants had completed about 7 years of schooling, and their fathers completed on average approximately 6.6 years of schooling. Almost 60% of the sample identified as comfortable or rich, and 41% identified as poor. Table 1 Demographic Characteristics of Ever-Married Young Women Aged 15–24 (N = 991) Characteristic N % Age at first marriage 10–17 444 55.2% = >18 547 44.8% Displacement status Displaced 527 53.2% Not displaced 464 46.8% Respondent Years of Education: Mean (SD) 6.94 (4.38) Father’s Years of Education: Mean (SD) 6.62 (5.30) Household of Origin Economic Status Comfortable, Rich, or Very Rich 585 59.0% Poor 406 41.0% Table 2 below shows patterns of premarital decision-making with age at first marriage and displacement status. Overall, 71% of young women responded that they were involved in the decision to marry, while only 29% said they were not involved in the decision. This percentage differed by age at marriage: about one-third (34%) of respondents married before the age of 18 said they were not involved in the decision to marry, compared with 22% of respondents who were married at or after age 18. Differences by displacement status were less pronounced, but also existed, with higher rates of displaced young women saying they were not involved in the decision to get married (32%) than those who were not displaced (25%). Table 2 Percent of Ever-Married Young Women Aged 15–24 Involved in Decision to Marry (N = 991) Involved (n, %) Not Involved (n, %) Age at marriage Married < 18 years old 359 65.5% 188 34.4% Married 18 + years old 345 77.7% 99 22.3% Pearson chi-square p-value p < 0.001 Displacement status Displaced 358 67.9% 169 32.1% Not displaced 346 74.6% 118 25.4% Pearson chi-square p-value p = 0.022 Total 704 71.0% 287 29.0% Factors associated with premarital decision-making Unadjusted associations between premarital decision-making and independent variables are shown in Table 3 . Child marriage and displacement status were the only two explanatory variables significantly associated with premarital decision-making. Compared with young women who were married at or after the age of 18, child brides who were married before the age of 18 had 82% higher odds of reporting lack of involvement in the decision to marry the first time [OR: 1.82, 95% CI: 1.37–2.43]. Compared with nondisplaced young women, those who were displaced at the time of the survey had 38% higher odds of saying that they were not involved in the decision to marry the first time [OR: 1.38, 95% CI: 1.04–1.83]. Number of years in school and household economic status were not significantly associated with involvement in decision-making Table 3 Unadjusted Odds Ratios for Lack of Involvement in Decision-Making Among Ever-Married Young Women (N = 991) Exposure Variable Odd Ratio 95% Confidence Interval Child brides (ref: nonchild brides) 1.82* 1.37–2.43 Displacement status (ref: not displaced) 1.38* 1.04–1.83 Years of education 0.99 0.96–1.02 Household Economic Status (ref: not poor) 1.19 0.90–1.56 *=p < 0.05 Results from the adjusted model are shown in Table 4 . After controlling for covariates, child marriage and displacement status were still significantly associated with reduced involvement in premarital decision-making. Holding all other covariates constant, child brides had 85% greater odds of saying they had little or no involvement in the decision to marry than did those married at age 18 or older (aOR: 1.85, 95% CI: 1.38–2.50), and displaced adolescents and young women had 36% greater odds of reporting little or no involvement than did those who were not currently displaced (aOR: 1.36, 95% CI: 1.01–1.81). Years of education and economic status of the household of origin were not statistically significant after controlling for other variables. Table 4 Adjusted Odds Ratios for Lack of Involvement in Decision-Making Among Ever-Married Young Women (N = 991) Exposure Variable Odd Ratio 95% Confidence Interval Child brides (ref: nonchild brides) 1.85* 1.38–2.50 Displacement status (ref: not displaced) 1.36* 1.01–1.081 Years of education 1.02 0.98–1.06 Household Economic Status (ref: not poor) 1.05 0.76–1.43 *=p < 0.05 Qualitative We draw on qualitative study findings to elucidate the premarital decision-making process and provide greater detail on how young women describe their involvement in the decision to marry. To contextualize these findings, we also present findings related to other motivations and influences on young women’s premarital decision-making, including pressures from community members, and misconceptions around roles and expectations in marriage. Marriage decision makers Fathers are the primary decision makers when it comes to marriage, though other family members, generally mothers or other male relatives, were also mentioned. Young women themselves were occasionally mentioned, but less frequently than other family members. Decision-making around marriage is not clear-cut. Most young women described the process as follows: a suitor often approaches the young woman’s father, who in turn assesses whether the suitor is a good match for his daughter. If they agree, they either discuss the proposition with the young woman directly or speak to other family members, such as the young woman’s mother, uncle or brother, who then solicit the young woman’s opinion. This tiered approach was frequently described, and rarely did respondents mention disagreeing if all the adult family members approved of the suitor beforehand. In this way, young women reported involvement in decision-making, but the extent to which they were able to refuse suitors was not clear. For example, one participant described, “In my father's opinion, the groom was a good person from a conservative family. First, he talked to my mother about it, then she talked to me. After I had prayed and my heart was at peace, I told them of my consent, and thus the decision was made” (Female IDP, Mareb, age 23, married at age 18).This excerpt exemplifies how young women ultimately make the decision to accept the proposals and how they view their roles as well as their family roles in the process. This process appeared to be largely consistent across both child brides and nonchild brides and by displacement status. There were, however, a couple of examples of alternative decision-making processes, such as other family members or the young woman being the critical decision maker, particularly when young women were not displaced. For example, as one participant described, “ My brother was the one who stood by me in the matter of my marriage and helped me to convince the parents to agree to it ” (Female host community, Aden, age 21, married at age 15). Motivations and influences on young women’s decision-making around marriage While qualitative data indicated that child marriages in this context often included consultation with young women, it was evident that their “approval” was often based on misconceptions around marriage and marriage roles, pressures from their family and the wider community and lack of alternatives to marriage. Frequently, when young women mentioned that they were involved in the decision to get married, their motivations were to either make their families happy or to escape the conditions of the natal household. Several respondents stated that they agreed to marriage in an attempt to pursue a better life. For example, as one young woman mentioned “ In my life there was nothing but housework actually, so I preferred marriage” (Female host community, Hadramaut, age 24, married at age 17). Another young woman mentioned “My father agreed and I wasn't thinking about marriage, but the harsh conditions in my father's house made me agree.” (Female IDP, Hadramaut, age 24, married at age 18). Numerous participants among both the IDP and host community groups described social and economic drivers of their own marriages, including from family, customs, traditions, and religion, peers, and pressure regarding a dowry. Many young women noted the pressure that community norms had on their decision to marry. Such women often stated that they accepted proposals to avoid negative perceptions or rumors about them. The fears of negative perceptions or reaching an age where young women are less desirable seem to strongly influence their decisions to accept proposals. When a girl refuses a proposal, women start talking about her badly; they may say that this girl does not have femininity or maybe she is a prostitute, so she rejects marriage proposals. Therefore, I accepted the first proposal because I do not want such nonsense to be said about me. – Female IDP, Aden, age 22, married at age 15 Economic drivers and related factors, such as dowries, were mentioned occasionally both among host community participants and IDP participants. For instance, one respondent stated, “ My father wanted to marry me off so that I could ease the burden on him, as he was in poor financial condition,” (Female host community, Aden, age 15, married at age 14). Traditionally, the groom’s family offers a dowry to the bride’s family to use on wedding expenses. A couple of respondents also mentioned protection as a reason for marriage and how it is viewed as a justification for child marriage. This view is illustrated in the quote “ But if appropriate, the husband is “suitable” as they say, he would marry even a 15-year-old girl. It’s better for her protection they say,” (Female host community, Hadhramaut, age 19, married at age 16). Premarriage perceptions and readiness for marriage Many young women, largely those married before age 18, mentioned that they were not aware of the responsibilities they would have once they entered into marriage. Several female respondents who were married before 18 years of age remarked that they did not fully understand the responsibilities that came with marriage or other components of marriage, including childbearing. Furthermore, a couple of female IDP participants who were married under 14 years of age described initial fear towards marriage, often citing fear of violence in the home. Both among IDP and host community participants, several respondents implied a reality in marriage different than expected. As one participant stated: “My dreams about marriage have portrayed it as a life of happiness without consequences” (Female IDP, Mareb, age 23, married at age 18). Similarly, one participant remarked “I thought of marriage as a simple thing without troubles” (Female IDP, Mareb, age 16, married at age 15). There was not a discernable difference between the IDP and host community in terms of perceived or reported readiness to be married; however, differences did appear by age at marriage. Among those who married at age 14 or younger, the vast majority reported not being ready for marriage given their young age. Many reported not knowing or understanding all that would be involved in marriage. Some respondents reported being excited about the wedding and white dress without seeming to understand expectations of marriage more deeply. Regardless of personal readiness, however, respondents discussed how marriage, even at young ages, is the norm in their society. “I felt that I was psychologically ready for marriage. It is normal for me to get married at this age, especially since it is the safe age for marriage. I was happy that I would live a new life” – Female IDP, Hadhramaut, age 20, married at age 18 “No, I wasn't ready at all. I was still young. But I was so excited about the white dress and the bridal stuff I was going to get.” – Female IDP, Aden, age 21, married at age 14 Impact of conflict and displacement on marriage decision-making IDP respondents were split between whether conflict and displacement affected decisions around marriage or the timing of their marriages. While not directly mentioning decision-making processes, reasons that conflict and displacement did affect marriage timelines were often stated simultaneously with the idea of marriage being up to “fate” and “god’s will”. Participants did not seem to differentiate between the effects of conflict and displacement, viewing them as indistinguishable. Several respondents also mentioned that the conflict would have changed the decision to marry, because they would have stayed in school. Marriage was not going to change, whether before or after the war. Marriage before the war was better in terms of providing the requirements and preparing the bride, but in terms of marriage, I would get married sooner or later any way. – Female IDP, Hadhramaut, age 23, married at age 14 If there hasn’t been war, I would have continued my study. Regarding marriage, if my destiny wanted, it would happen. – Female IDP, Marib, age 22, married at age 19 I did not complete my study due the conflict, and even if I hadn’t completed my study, I would get married at an elder age. – Female IDP, Aden, age 20, married at age 17 Host community respondents were also split on whether the conflict had an impact on their marriage decisions. Of those that responded in the affirmative, most indicated that they would have been married later if not for the conflict. Women who indicated that they would have been married later stated that they would have continued their education. Yes, I would have got married a little later and completed my university studies. But because of the war, I was convinced that there was no use in education as long as I could not find a job. – Female host community, Aden, age 23, married at age 17 Discussion We find that young women reported a relatively high level of decision-making surrounding marriage, though involvement was significantly lower for those who married before age 18 and for those who were displaced. Qualitative data complicate this understanding by highlighting both the complex process through which proposals are made and the constrained context in which young women make decisions—marked by social norms supporting child marriage, limited educational and economic opportunities, and challenging conditions in their natal homes. In our study, 71% percent of young women said they were either completely or very involved in the decision to marry, indicating a high degree of reported involvement. We did find lower decision-making for those who were married before age 18, but findings from this study add nuance to the dominant child marriage discourse that child brides are unaware and forced into their marriages without personal involvement.(25,30) Specifically, the qualitative data highlight that while involvement in the marriage decision process is common, such involvement may not reflect complete agency or autonomy in decision-making around marriage. Young women are often asked to consent to marriage after a father or other elder or relatively have already decided that a marriage should take place. Qualitative results also highlight that child brides reported lower readiness to be married and were less aware of the responsibilities of marriage. Thus, their involvement may be mostly superficial, and though young women may report decision-making involvement, such involvement may not be a demonstration of true autonomy. These findings raise questions about young women’s ability to exercise full decision-making over their marriages when they may not fully comprehend the choices presented to them and face a significant lack of viable alternatives for pathways to adulthood and social and familial pressure to conform. Our study findings highlight the need to more clearly understand how to define autonomy and agency in marriage and how such a construct applies to contexts in which young women are choosing marriage to escape harsh conditions or are without alternative options. Starting with the definition of Ahearn in which agency refers to “the socioculturally mediated capacity to act,” we can consider agency in the decision to marry as the capacity to act and make decisions around marriage.(31) Murphy-Graham and Leal expand on this thinking to apply the concepts of “thin” and “thick” agency to child marriage, in which thin agency refers to marriage decisions made in highly restrictive contexts, whereas thick agency refers to decision-making with a wider availability of options.(32) Our qualitative findings support the widespread presence of what has been described in the literature as “thin” agency in which decisions are made under considerable pressure from intersecting structural constraints. Such constraints include entrenched gender norms that normalize child marriage, restricted access to formal education and labor markets, household environments that are unstable, and households marked by economic insecurity or gendered expectations around obedience and pronatalism. These findings align with research among Syrian refugees, which also found that young women felt pressure to consent to marriage due to a lack of alternatives and other opportunities.(33) Efforts to eliminate child marriage globally must engage more critically with the realities of such constrained agency and the gender and social systems that result in “thin” choices. Framing child marriage solely as a matter of individual choice or awareness is insufficient; rather, interventions must confront the broader sociocultural and economic systems that systematically narrow the scope of options available to adolescent girls and young women. Addressing the root causes of “thin” agency requires sustained efforts to transform the gendered social structures, economic vulnerabilities, and normative frameworks that shape girls’ trajectories from a young age. In this context, deepening young women’s ability to exercise what has been termed “thick” agency must be seen as a central goal of child marriage prevention. This is particularly urgent given robust evidence that greater autonomy and decision-making power among women and girls are closely linked to an array of improved reproductive health outcomes, including contraceptive uptake, prenatal care, and antenatal service.( 20 , 22 – 24 ) Efforts to deepen agency and address systemic barriers to alternatives to marriage are particularly important for displaced young women. The global community is currently failing to build this population’s agency, as governments often do not view child marriage as an urgent issue or as one on which they can make a substantial impact.(2,32) Interventions should aim to change the underlying conditions that make marriage an appealing solution. Young women noted that viable alternatives to marriage, specifically education and labor activities, were impacted by conflict and displacement, both for displaced and host communities, thereby restricting the degree of full agency in marriage that they have. Such disruptions are typical of complex humanitarian emergencies, but education and employment are also the most effective means to prevent child marriage by providing alternative means for economic security and shifting gender norms around expected roles of women.(12,29,34) While humanitarian response in emergencies must prioritize restoring safety and security, in the longer term, response efforts must not neglect the restoration of education and labor opportunities and ensure that these are available to both males and females. Providing young women with greater access to meaningful opportunities through education and employment can cultivate their aspirations, enabling them to see themselves as more than wives, and increase their understanding of health relationships. On the whole, a more comprehensive understanding of the practice of early and child marriage is essential given that international terminology and norms are evolving, and researchers are acknowledging that both marriage and girlhood mean different things across the world.(35) As Giaquinta writes, while “international development organizations acknowledge children have the capacity to participate and make decisions about certain [things] like their educational experience, they continue to refute the idea that youth possess the sexual agency and maturity to consent to marriage and thus justify the need to control young women’s sexual bodies through interventions to end child marriage”.( 25 ) At the same time, ascertaining how much coercion and familial roles are present in the process provides public health practitioners with insight into better research priorities and programming to address forced child marriages. Future research should further examine how societal context and social norms influence autonomy in marriage decision-making and its consequences for young women and men. These findings should be considered in light of some limitations. There was only one question on decision-making, which may not offer an adequate and full representation of the construct of autonomy and choice, as indicated by the qualitative data. More research is needed to improve the measurement of autonomy and decision-making for young women, particularly in the context of constrained choice. In addition, the question was not asked of those who were not married; young women with more decision-making power may have exercised that choice and not gotten married, thus introducing selection bias into our sample. Nonetheless, our results indicate that among those who were married, decision-making does vary by age at marriage and displacement status, findings that are further supported by the qualitative data. Finally, given the highly contextualized nature of conflict, it is difficult to ascertain how much of this analysis can be generalized to other settings. The strengths of this study include that it was conducted during an active humanitarian emergency. The research team was able to survey a large study sample and collect data on a comprehensive set of independent factors to test associations with decision-making. Additionally, this analysis offered the unique perspective of assessing decision-making in child marriage as opposed to factors associated with the marriage itself, in an attempt to gain a more nuanced understanding of the experience. Furthermore, the use of both quantitative and qualitative data adds a nuanced understanding of young women’s decision-making power around marriage in humanitarian settings. Conclusion This study assessed the association between premarital decision making and age of marriage among married young women in Yemen. The results indicate that while most young women state that they were involved in the decision to marry, involvement in premarital decision-making was significantly lower for young women who marry before 18 years of age and for displaced young women. In addition, while most young women do state that they have autonomy in the decision to marry, it is unclear to what extent this is true given the number of people and other external factors influencing their decision. By using premarital decision-making as the outcome of interest, this research attempted to better assess young women’s relationship with and opinions of marriage in view of their own life experiences. Research on autonomy in marriage decisions has implications for how the global community views and continues to research marriage decision-making in humanitarian settings in the future. Abbreviations CEFM: child, early, and forced marriage CI: confidence interval EMEC: Early Marriage and Early Childbearing project IDI: in-depth interview IDP: internally displaced person R2HC: Research for Health in Humanitarian Crises programme Declarations Ethical approval Data collection was approved by the Institutional Review Board of the Johns Hopkins Bloomberg School of Public Health [Ref Number 21168] and the Yemen IRB, the Ethical Review Board of the Ministry of Health. Both review boards approved informed verbal consent/assent to be obtained from study participants, as many participants were from rural areas and were not able to read and write. Consent for publication We obtained verbal consent from unmarried participants aged 18 years old and older and married girls aged 15–17 years old who were considered emancipated minors in this context. For unmarried girls aged 15-17, verbal assent coupled with oral permission from their parent/guardian was used. Availability of data and materials The data that support the findings of this study are available from the authors upon reasonable request and with the permission of Norwegian Social Research (NOVA). Competing Interests The authors declare no competing interests. Funding This research project is funded by Elrha’s Research for Health in Humanitarian Crises (R2HC) programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome, and the Department for Health and Social Care (DHSC) through the National Institute for Health Research (NIHR). Author contributions CG conducted final quantitative and qualitative data analysis and prepared the final draft of the manuscript. HT conducted the quantitative data analysis and initial qualitative data analysis and drafted sections of the manuscript. CG and HT contributed equally and share first authorship. TA, AA, and AAK led the local data collection, contributed to interpretation, and participated in the development of the manuscript. BA, CR, LZ, and SE designed and conceptualized the study, provided oversight during its implementation, and provided feedback on the manuscript. LZ and SE oversaw the data analysis and manuscript development. All authors read and approved the final manuscript. References Child marriage | UNICEF [Internet]. [cited 2025 May 21]. Available from: https://www.unicef.org/protection/child-marriage Mazurana D, Marshak A, Spears K. International Review of the Red Cross. 2019 [cited 2025 May 21]. Child marriage in armed conflict. Available from: http://international-review.icrc.org/articles/child-marriage-armed-conflict Central Statistical Organization (CSO) and United Nations Children’s Fund (UNICEF). Yemen Multiple Indicator Cluster Survey 2022-2023, Survey Findings Report [Internet]. Yemen: Central Statistical Organization and United Nations Children’s Fund; 2023 [cited 2025 May 21]. Available from: https://www.unicef.org/yemen/documents/yemen-mics-multiple-indicator-cluster-survey Elnakib S, Zimmerman LA, Attal B, Alkebsi T, Aldaram A, Al Kaff A, et al. Changing patterns of family formation among internally displaced populations in Yemen: evidence from cross-sectional surveys. BMC Public Health. 2024 Dec 3;24(1):3365. Nour NM. Child Marriage: A Silent Health and Human Rights Issue. Rev Obstet Gynecol. 2009;2(1):51–6. Fan S, Koski A. The health consequences of child marriage: a systematic review of the evidence. BMC Public Health. 2022 Feb 14;22:309. Kohno A, Techasrivichien T, Suguimoto SP, Dahlui M, Farid NDN, Nakayama T. Investigation of the key factors that influence the girls to enter into child marriage: A meta-synthesis of qualitative evidence. PLOS ONE. 2020 Jul 17;15(7):e0235959. Elnakib S, Elsallab M, Wanis MA, Elshiwy S, Krishnapalan NP, Naja NA. Understanding the impacts of child marriage on the health and well-being of adolescent girls and young women residing in urban areas in Egypt. Reproductive Health. 2022 Jan 15;19(1):8. Dadras O, Khampaya T, Nakayama T. Child Marriage, Reproductive Outcomes, and Service Utilization among Young Afghan Women: Findings from a Nationally Representative Survey in Afghanistan. Studies in Family Planning. 2022;53(3):417–31. Girls Not Brides [Internet]. [cited 2025 May 21]. About child marriage. Available from: https://www.girlsnotbrides.org/about-child-marriage/ Dean L, Obasi A, Sony AE, Fadul S, Hassan HE, Thomson R, et al. “He is suitable for her, of course he is our relative”: a qualitative exploration of the drivers and implications of child marriage in Gezira State, Sudan. BMJ Glob Health [Internet]. 2019 May 28 [cited 2025 May 21];4(3). Available from: https://gh.bmj.com/content/4/3/e001264 Greene ME, Stiefvater E. Social and gender norms and child marriage: A reflection on issues, evidence and areas of inquiry in the field [Internet]. London: ALIGN; 2019 Apr [cited 2025 May 21]. Available from: https://www.alignplatform.org/resources/2019/04/social-gender-norms-and-child-marriage 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. Journal of Adolescent Health. 2021 Dec 1;69(6, Supplement):S13–22. Presler-Marshall E, Jones N, Alheiwidi S, Youssef S, Hamad BA, Odeh KB, et al. Through their eyes: exploring the complex drivers of child marriage in humanitarian contexts [Internet]. GAGE. 2020 [cited 2025 May 21]. Available from: https://www.gage.odi.org/publication/through-their-eyes-exploring-the-complex-drivers-of-child-marriage-in-humanitarian-contexts/ 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. Child Marriage in the Middle East and North Africa – Yemen Country Brief [Internet]. United Nations Children’s Fund (UNICEF) Middle East and North Africa Regional Office in collaboration with the International Center for Research on Women (IRCW); 2017 [cited 2025 May 21]. Available from: https://www.unicef.org/mena/media/1821/file/%20MENA-CMReport-YemenBrief.pdf.pdf Mazurana D, Marshak. Addressing Data Gaps on Child Marriage in Humanitarian Settings [Internet]. [cited 2025 May 21]. Available from: https://fic.tufts.edu/publication-item/data-gaps-child-marriage-in-humanitarian-settings/ Girls Not Brides. Girls Not Brides. [cited 2025 May 21]. Child marriage atlas - Girls Not Brides. Available from: https://www.girlsnotbrides.org/learning-resources/child-marriage-atlas/atlas/yemen/ 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. De-Juanas Á, Bernal Romero T, Goig R. The Relationship Between Psychological Well-Being and Autonomy in Young People According to Age. Front Psychol [Internet]. 2020 Dec 10 [cited 2025 May 21];11. Available from: https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.559976/full Crandall A, VanderEnde K, Cheong YF, Dodell S, Yount KM. Women’s age at first marriage and postmarital agency in Egypt. Social Science Research. 2016 May 1;57:148–60. Bloom SS, Wypij D, Das Gupta M. Dimensions of women’s autonomy and the influence on maternal health care utilization in a north Indian city. Demography. 2001 Feb;38(1):67–78. Furuta M, Salway S. Women’s Position Within the Household as a Determinant Of Maternal Health Care Use in Nepal. International Perspectives on Sexual and Reproductive Health. 2006 Mar 1;32:17. Woldemicael G. Do Women With Higher Autonomy Seek More Maternal Health Care? Evidence From Eritrea and Ethiopia. Health Care for Women International. 2010 Jun 10;31(7):599–620. Giaquinta B. Silenced subjectivities & missed representations: Unpacking the gaps of the international child marriage discourse. In 2016 [cited 2025 May 21]. Available from: https://www.semanticscholar.org/paper/Silenced-subjectivities-%26-missed-representations%3A-Giaquinta/b296a083eeac20da29c52a858a9842510c302d5c Conflict in Yemen and the Red Sea | Global Conflict Tracker [Internet]. [cited 2025 May 21]. Available from: https://www.cfr.org/global-conflict-tracker/conflict/war-yemen World Bank. Macro Poverty Outlook for Yemen, Republic of : October 2024 [Internet]. Washington, DC: World Bank Group; 2024 Oct [cited 2025 May 22]. (Macro Poverty Outlook (MPO)). Report No.: 194058. Available from: http://documents.worldbank.org/curated/en/099626510152416893 Yemen | Annual DTM Report on Displacement 2023 [Internet]. International Organization for Migration; 2024 [cited 2025 May 21]. Available from: https://dtm.iom.int/sites/g/files/tmzbdl1461/files/reports/20240207_YEMEN%20-%20Annual%20DTM%20Report%20for%20Displacement%202023_1_0.pdf?iframe=true Malhotra A, Elnakib S. Evolution in the Evidence Base on Child Marriage 2000–2019 [Internet]. UNFPA-UNICEF Global Programme to End Child Marriage; 2021 Jan [cited 2025 May 21]. Available from: https://www.unicef.org/media/91991/file/Child-marriage-evidence-report-2021.pdf Save the Children [Internet]. 2020 [cited 2025 May 21]. Child Marriage: A Violation of Child Rights. Available from: https://www.savethechildren.org/us/charity-stories/child-marriage-a-violation-of-child-rights Ahearn LM. Language and Agency. Annual Review of Anthropology. 2001 Oct 1;30(Volume 30, 2001):109–37. Murphy-Graham E, Leal G. Child Marriage, Agency, and Schooling in Rural Honduras. Comparative Education Review. 2015 Feb;59(1):24–49. Zuntz AC, Palattiyil G, Amawi A, Al Akash R, Nashwan A, Al Majali A, et al. Early marriage and displacement—a conversation: how Syrian daughters, mothers and mothers-in-law in Jordan understand marital decision-making. The British Academy [Internet]. 2021 Jul 15 [cited 2025 May 21]; Available from: https://www.thebritishacademy.ac.uk/publishing/journal-british-academy/9/early-marriage-and-displacement/ Malhotra A, Elnakib S. 20 Years of the Evidence Base on What Works to Prevent Child Marriage: A Systematic Review. Journal of Adolescent Health. 2021 May 1;68(5):847–62. Efevbera Y, Bhabha J. Defining and deconstructing girl child marriage and applications to global public health. BMC Public Health. 2020 Dec;20(1):1–11. Additional Declarations No competing interests reported. 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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-6762440","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":469944291,"identity":"887e57dc-18be-4bd8-a334-46f6028a6c61","order_by":0,"name":"Charlotte Greenbaum","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYPCCA3L8DGdADGbitRhLNpCqJXHDAR4itfD3r3344OOOO8bGB88ek2CosE5sIKRF4sZzY8OZZ57JmR04lybBcCadsBYDiWNs0rxth43NDpwxk2BsO0yUFvbff4EqNzeAtPwjRgt/GxszyPANDCAtDURokbjBxizZ2/bMWOLAGWOLhGPpxgS18PcfY/zws+2OHP+MM4Y3PtRYyxLUwiCRAGMcYGBIwK0O2ZoDMAZh40fBKBgFo2CEAgDwRkTUYYyppAAAAABJRU5ErkJggg==","orcid":"","institution":"Johns Hopkins Bloomberg School of Public Health","correspondingAuthor":true,"prefix":"","firstName":"Charlotte","middleName":"","lastName":"Greenbaum","suffix":""},{"id":469944292,"identity":"40c5b9ca-5138-4be9-b4d8-eb8664c94ad0","order_by":1,"name":"Huda Tauseef","email":"","orcid":"","institution":"Johns Hopkins Bloomberg School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Huda","middleName":"","lastName":"Tauseef","suffix":""},{"id":469944293,"identity":"c9afb053-36e7-4452-9a54-db947d491854","order_by":2,"name":"Tareq Alkebsi","email":"","orcid":"","institution":"Central Statistical Organisation","correspondingAuthor":false,"prefix":"","firstName":"Tareq","middleName":"","lastName":"Alkebsi","suffix":""},{"id":469944294,"identity":"dc30528c-7f43-434c-b8b3-0791986cfe4e","order_by":3,"name":"Aisha AlDaram","email":"","orcid":"","institution":"Building Foundation for Development","correspondingAuthor":false,"prefix":"","firstName":"Aisha","middleName":"","lastName":"AlDaram","suffix":""},{"id":469944295,"identity":"608fe355-1d63-49a5-b3bc-fa71b3f4f0a3","order_by":4,"name":"Abudallah Al Kaff","email":"","orcid":"","institution":"Building Foundation for Development","correspondingAuthor":false,"prefix":"","firstName":"Abudallah","middleName":"Al","lastName":"Kaff","suffix":""},{"id":469944298,"identity":"26395d42-c851-4294-b8d5-06f194b27523","order_by":5,"name":"Bothaina Attal","email":"","orcid":"","institution":"Sana'a University","correspondingAuthor":false,"prefix":"","firstName":"Bothaina","middleName":"","lastName":"Attal","suffix":""},{"id":469944300,"identity":"9852edeb-e83c-4490-a119-a169f62f1a80","order_by":6,"name":"W. Courtland Robinson","email":"","orcid":"","institution":"Johns Hopkins Bloomberg School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"W.","middleName":"Courtland","lastName":"Robinson","suffix":""},{"id":469944303,"identity":"9d955080-cf05-40fa-b426-f90311ba8fdd","order_by":7,"name":"Shatha Elnakib","email":"","orcid":"","institution":"Johns Hopkins Bloomberg School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Shatha","middleName":"","lastName":"Elnakib","suffix":""},{"id":469944305,"identity":"b3460213-480e-4915-a96b-1698ff3cc0ff","order_by":8,"name":"Linnea Zimmerman","email":"","orcid":"","institution":"Johns Hopkins Bloomberg School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Linnea","middleName":"","lastName":"Zimmerman","suffix":""}],"badges":[],"createdAt":"2025-05-27 20:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6762440/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6762440/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98627774,"identity":"fec3fc84-0db7-4d6b-b180-bdd8d3f83566","added_by":"auto","created_at":"2025-12-19 17:10:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":802658,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6762440/v1/09642460-9500-4cae-87c0-e504d380a7aa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Consent and Conflict: Factors Associated with Premarital Decision-Making for Young Women in Conflict-Affected Settings in Yemen","fulltext":[{"header":"Background","content":"\u003cp\u003eAlthough the rate of child, early, and forced marriage (CEFM) has decreased over the last decade, one in five girls globally will still be married before age 18.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) By 2030, an additional 150\u0026nbsp;million girls will be married.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) In Yemen, the latest Multiple Indicator Cluster Survey from 2022-23 estimated that approximately 30% of young women aged 20\u0026ndash;24 years were married by age 18.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Other recent research found similar estimates with higher rates of marriage by age 18 among ever-displaced and never-displaced women.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) While the pathways involved in child marriage and the role of premarital factors remain unclear, child marriage increases the risk for several adverse health outcomes and conditions, including increased risk of maternal and neonatal health complications, sexually transmitted infections, depression, malaria, and cervical cancer.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Girls who marry before they turn 18 are also less likely to remain in school, less likely to receive antenatal care, and more likely to experience intimate partner violence, potentially excluding them from participating in their communities and damaging their physical and psychological well-being.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe drivers of child marriage vary greatly across settings, but researchers have identified multiple factors, including social norms and attitudes, particularly gender norms that serve to stigmatize young women\u0026rsquo;s sexuality and reinforce traditional roles for women such as mothers, wives, and caretakers. These factors are frequently exacerbated by poverty and/or lack of economic and education opportunities.(\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) Evidence suggests that in periods of conflict and instability, these underlying drivers may be amplified, resulting in higher rates of child marriage. Indeed, seven out of ten countries with the highest rates of child marriage were considered fragile states in 2017 and six of these countries were experiencing armed conflict and/or hosting conflict-displaced populations.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Fear of real or perceived threats of increased violence,(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) economic instability triggered by crisis-related displacement,(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and a lack of education opportunities as an alternative to marriage due to disruptions in educational systems(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) may all drive increased child marriage. A lack of parental awareness of the potential negative consequences of child marriage may also contribute to higher rates, coupled with a severe lack of support and competing priorities to ensure health and safety.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) However, gaps remain in understanding how context-specific factors affect child marriage and the marriage decision-making process in humanitarian settings.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) In Yemen, Girls Not Brides identifies poverty, limited education, family honor, COVID-19-related disruptions, and vulnerabilities related to the ongoing humanitarian crisis as drivers of child marriage in the country.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Recent research by coauthors, conducted under the same project as the current study, has also revealed that not having attended school and having an unemployed female adult in the household are associated with an increased risk of child marriage in Yemen. Economic factors are often cited in decision-making around entering marriage as well.(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) While research has identified these drivers, less attention has been given to understanding the involvement of young women themselves in the process of child marriage, including their decision-making and potential motivations to marry when living in situations characterized by poverty and a lack of opportunity.\u003c/p\u003e \u003cp\u003eAlthough autonomy and choice are factors closely tied to overall health and well-being, they have been frequently neglected in research on child marriage.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Research in Egypt found an association between age at marriage and measures of agency, but this relationship was not significant after accounting for premarital factors.(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) The current literature links reduced autonomy within marriage to worse health outcomes, such as worse maternal health outcomes and lower use of contraception,(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) but few studies address autonomy with respect to the decision to marry. While child marriage is understood in the global community as a strict violation of human rights and thus a practice that requires elimination, research has rarely explored the exercise of agency among young women in matters related to their marriage or reasons why such women may express a preference toward marriage.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) For example, prevailing narratives around child marriage in the literature depict young women as lacking agency in the choice to marry; however, some studies have revealed that they can exercise agency to pursue marriage in situations where they lack alternative options.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) The few studies that explore the role of agency in crisis settings offer a complex story. Families frequently state that young women are given a choice to refuse suiters and assert their preferences; however, young women explain that family elders have considerable influence over their decision.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) This influence, combined with young women\u0026rsquo;s perceptions that child marriage is a norm in their communities, results in very few young women admitting that they are forced into their marriage. Instead, many believe that they are ready for marriage and that the decision is their own.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eTo address the current research gaps in the understanding of autonomy in decision-making around marriage, particularly in situations of conflict, this research uses quantitative and qualitative data to explore factors associated with perceived involvement in decision-making at time of first marriage among young women in Yemen. Specifically, we examine the associations between perceived involvement in the decision to marry, one\u0026rsquo;s age at marriage, and one\u0026rsquo;s displacement status using quantitative survey data from a sample of displaced and nondisplaced young women residing in Yemen. We then use qualitative data collected through in-depth interviews with married young women to contextualize these findings and center the voices of young women in explaining decisions surrounding marriage.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting\u003c/h2\u003e \u003cp\u003eFor nine years, Yemen has been in a conflict described as the worst humanitarian crisis in the world by the United Nations.(26) In 2014, civil war broke out in the country between Houthi forces and President Abd Rabbu Mansur Hadi\u0026rsquo;s government. Saudia Arabia, backed by US intelligence, led a counteroffensive attack via an economic embargo and airstrikes after the government was overthrown and left citizens trapped and living in famine conditions. According to the United Nations and the World Bank, in 2021, nearly 24\u0026nbsp;million people, or 80% of the population, were in need of humanitarian protection and aid, or were at risk for hunger and disease. Prior to this conflict, Yemen was already the poorest country in the region, and since 2014, this crisis has compounded already severe challenges to the education, water and sanitation, and healthcare systems.(16,26,27) In this context, the current study focused on three governorates in Yemen representing three of the five governorates with the largest number of internally displaced persons: Aden, Hadramout, and Ma\u0026rsquo;arib.(28) These governorates were purposively selected based on the feasibility of data collection and the large number of displaced individuals. Aden, the capital of the internationally recognized government, has experienced relative stability compared with other parts of Yemen, making it a feasible location for data collection despite ongoing humanitarian needs and displacement flows. Hadramout has remained comparatively secure throughout the conflict, serving as a destination for displaced populations from more conflict-affected regions. Ma\u0026rsquo;rib hass been actively affected by active conflict and hosts one of the highest concentrations of internally displaced persons (IDPs) in the country.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData\u003c/h3\u003e\n\u003cp\u003eThe data for this study come from the Research for Health in Humanitarian Crises (R2HC)-funded Early Marriage Early Childbearing (EMEC) study, conducted in 2022 in the most densely populated districts of the governorates of Aden, Hadramout, and Ma\u0026rsquo;arib. This analysis uses data from both the quantitative adolescent survey and the in-depth interviews with married young women.\u003c/p\u003e\n\u003ch3\u003eQuantitative methods\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample\u003c/h2\u003e \u003cp\u003eDistricts within each governorate were selected using different approaches due to ongoing safety and security concerns at the time of data collection. In Aden, districts were selected with probability proportional to the size of the district. In Hadramaut, given the large number and geographic dispersion of districts, six districts with sizeable IDP populations (over 2000\u0026thinsp;+\u0026thinsp;IDPs residing in the district) were purposively selected. Finally, in Ma\u0026rsquo;arib, only two districts that were under the jurisdiction of the Aden government were selected. Zones, which served as clusters, were then selected across districts, again differing across governorate due to safety concerns. In Aden, 20 zones were selected with probability proportional to size. A total of 20 zones of 20 households (10 IDPs and 10 hosts) each were selected in each district. In Hadramout, which lacked zone-level data, community guides identified zones/areas with a comparatively higher concentration of IDPs. These zones served as our clusters. Twenty zones were selected in each district. In Ma\u0026rsquo;arib, 15 zones and 40 subzones were selected using probability proportional to size. The subzones served as the cluster. In each cluster, a random start was selected using the \u0026ldquo;spin the pen approach\u0026rdquo;; data collectors started at a random landmark and spun a pen to randomly select a direction. They then went to the nearest household in that direction and screened it for eligibility. Eligibility was defined as having at least one young woman between the ages of 15 and 24 who had lived in the household for at least one month. The next household was selected using the same method and the process continued until the sample size was reached in each zone.\u003c/p\u003e \u003cp\u003eA total sample size of 1600 households was calculated with the goal of ensuring precision of prevalence estimates. The 1600 households were disproportionately allocated across the three governorates. Participants were oversampled in Ma\u0026rsquo;arib given the large number of IDPs. In total, we selected 400 IDPs and hosts in Aden, 400 IDPs and hosts in Hadramaut, and 800 IDPs and hosts in Ma\u0026rsquo;arib. For the purpose of the interviews, IDPs were self-identified as displaced due to the conflict. Hosts were defined as those living in close proximity to the IDPs included in the study. Data collection was carried out using two survey instruments: a brief household questionnaire, answered by an adult female, and a questionnaire on child marriage and childbearing that was administered to one to two young women aged 15\u0026ndash;24 per household. If there were one or two adolescents in the household, both were eligible to respond; if there were more than two, two were randomly selected.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcomes of interest\u003c/h3\u003e\n\u003cp\u003eOur primary outcome variable of interest assessed autonomy and involvement in decision-making in one\u0026rsquo;s first marriage using the following question in the survey: \u003cem\u003e\u0026ldquo;How much were you involved in the decision to get married the FIRST time?\u0026rdquo;.\u003c/em\u003e Respondents could answer \u0026ldquo;completely\u0026rdquo;, \u0026ldquo;very much\u0026rdquo;, \u0026ldquo;not very much\u0026rdquo;, or \u0026ldquo;not at all\u0026rdquo;. This question was recoded as a binary variable consisting of \u0026ldquo;involved\u0026rdquo; (completely/very much\u0026rdquo;) and \u0026ldquo;not involved\u0026rdquo; (not very much/not at all). As decision-making for a second marriage would likely involve different actors and processes than those for the first, for the 20 women who had been married more than once we used information only on perceived decision-making involvement of their first marriage.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIndependent Variable\u003c/h2\u003e \u003cp\u003eAs our primary question of interest assessed whether decision-making differed by age at marriage, our main independent variable of interest was a binary response to capture the experience of child marriage, defined as whether the young woman was less than 18 at the time of her first marriage. Young women married for the first time before 18 years of age were coded as child brides, while those married for the first time at 18 years of age or older were coded as nonchild brides. Our second question of interest was whether autonomy varied by displacement status. Displacement status was self-reported based on whether respondents reported being displaced from their location of origin due to conflict. Adolescents who reported that they had moved from their place of origin for reasons other than conflict were not considered displaced.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCovariates\u003c/h3\u003e\n\u003cp\u003eWe included additional covariates that we hypothesized could confound the relationship between age at marriage and marriage decision-making, based on previous literature. These include level of education and economic status of the household of origin.(29) Education was included as a continuous variable of the number of years of schooling the respondent had completed. Household economic status was a self-reported scale, wherein respondents were asked if they would categorize the economic status of their household of origin as very rich, rich, comfortable, or poor. This measure was condensed to a binary variable, comparing those who were comfortable, rich, or very rich to those who identified as poor. Owing to the significant correlation between displacement status and region, we did not include region as our primary objective was to isolate the effect of displacement. All analyses were conducted using STATA Version 18.1.\u003c/p\u003e\n\u003ch3\u003eAnalytic Sample\u003c/h3\u003e\n\u003cp\u003eA total of 1,773 young women responded to the adolescent survey. Of those 1,733 respondents, 998 were currently or previously married and thus answered the marriage decision-making question. After accounting for missing data from other covariates of interest, the final analytical sample consisted of 991 young women.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive analysis was initially used to explore the data and ascertain the distribution of and variation across variables of interest. Thereafter, unadjusted and adjusted binary logistic regression models were employed to estimate odds ratios and 95% confidence intervals for associations between involvement in the decision to marry (reference group denoted lack of involvement and was coded as 0) and age at first marriage.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eQualitative methods\u003c/h2\u003e \u003cp\u003eQualitative data collected in this study include in-depth interviews with married young women and key informant interviews with community leaders, religious leaders, humanitarian actors, and service providers. For this analysis, we used data collected through in-depth interviews (IDIs) among 47 married young women. The participants in the IDIs were purposively selected, referred by other study participants, or identified during the conduct of the survey.\u003c/p\u003e \u003cp\u003eAll interviews were transcribed and translated into English and coded upon completion. The interview transcripts were analyzed using latent content analysis methods. The research team coded all transcripts using Dedoose, creating and refining codebooks using both inductive codes developed from previous research and deductive codes that emerged during analysis. Analysts met weekly during the coding phase to engage in memo-writing, reflexivity exercises, discuss emergent themes for additional codes, and identify any issues of inconsistencies with coding and/or the codebook. Once all transcripts were coded, summaries of the themes emerging within and across codes were developed. For this study, codes related to marriage decisionmakers, perceptions of marriage, motivations behind marriage, and the impact of conflict and displacement on marriage were extracted from the already coded transcripts. Within each code, excepts were analyzed to look for differences in emerging themes by age at marriage (before or after 18) and displacement status.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative\u003c/h2\u003e \u003cp\u003eRespondent characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below. Of the 991 respondents who were ever married, about 55% were married before 18 years of age. Of note, 10% of young women were married before age 15 (not shown). As expected, given our quota sampling, approximately half of the survey population was displaced (53% displaced versus 47% not displaced). On average, participants had completed about 7 years of schooling, and their fathers completed on average approximately 6.6 years of schooling. Almost 60% of the sample identified as comfortable or rich, and 41% identified as poor.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of Ever-Married Young Women Aged 15\u0026ndash;24 (N\u0026thinsp;=\u0026thinsp;991)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at first marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e= \u0026gt;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisplacement status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisplaced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot displaced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespondent Years of Education: Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(4.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather\u0026rsquo;s Years of Education: Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(5.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold of Origin Economic Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComfortable, Rich, or Very Rich\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below shows patterns of premarital decision-making with age at first marriage and displacement status. Overall, 71% of young women responded that they were involved in the decision to marry, while only 29% said they were not involved in the decision. This percentage differed by age at marriage: about one-third (34%) of respondents married before the age of 18 said they were not involved in the decision to marry, compared with 22% of respondents who were married at or after age 18. Differences by displacement status were less pronounced, but also existed, with higher rates of displaced young women saying they were not involved in the decision to get married (32%) than those who were not displaced (25%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercent of Ever-Married Young Women Aged 15\u0026ndash;24 Involved in Decision to Marry (N\u0026thinsp;=\u0026thinsp;991)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInvolved\u003c/p\u003e \u003cp\u003e(n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNot Involved\u003c/p\u003e \u003cp\u003e(n, %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at marriage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u0026thinsp;\u0026lt;\u0026thinsp;18 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried 18\u0026thinsp;+\u0026thinsp;years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePearson chi-square p-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisplacement status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisplaced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot displaced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePearson chi-square p-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e704\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e71.0%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e287\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e29.0%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with premarital decision-making\u003c/h2\u003e \u003cp\u003eUnadjusted associations between premarital decision-making and independent variables are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Child marriage and displacement status were the only two explanatory variables significantly associated with premarital decision-making. Compared with young women who were married at or after the age of 18, child brides who were married before the age of 18 had 82% higher odds of reporting lack of involvement in the decision to marry the first time [OR: 1.82, 95% CI: 1.37\u0026ndash;2.43]. Compared with nondisplaced young women, those who were displaced at the time of the survey had 38% higher odds of saying that they were not involved in the decision to marry the first time [OR: 1.38, 95% CI: 1.04\u0026ndash;1.83]. Number of years in school and household economic status were not significantly associated with involvement in decision-making\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnadjusted Odds Ratios for Lack of Involvement in Decision-Making Among Ever-Married Young Women (N\u0026thinsp;=\u0026thinsp;991)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExposure Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdd Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild brides (ref: nonchild brides)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.82*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.37\u0026ndash;2.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisplacement status (ref: not displaced)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.38*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.04\u0026ndash;1.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u0026ndash;1.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold Economic Status (ref: not poor)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.90\u0026ndash;1.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*=p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eResults from the adjusted model are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. After controlling for covariates, child marriage and displacement status were still significantly associated with reduced involvement in premarital decision-making. Holding all other covariates constant, child brides had 85% greater odds of saying they had little or no involvement in the decision to marry than did those married at age 18 or older (aOR: 1.85, 95% CI: 1.38\u0026ndash;2.50), and displaced adolescents and young women had 36% greater odds of reporting little or no involvement than did those who were not currently displaced (aOR: 1.36, 95% CI: 1.01\u0026ndash;1.81). Years of education and economic status of the household of origin were not statistically significant after controlling for other variables.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdjusted Odds Ratios for Lack of Involvement in Decision-Making Among Ever-Married Young Women (N\u0026thinsp;=\u0026thinsp;991)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExposure Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdd Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild brides (ref: nonchild brides)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.85*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.38\u0026ndash;2.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisplacement status (ref: not displaced)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.36*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.01\u0026ndash;1.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98\u0026ndash;1.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold Economic Status (ref: not poor)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.76\u0026ndash;1.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*=p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eQualitative\u003c/h2\u003e \u003cp\u003eWe draw on qualitative study findings to elucidate the premarital decision-making process and provide greater detail on how young women describe their involvement in the decision to marry. To contextualize these findings, we also present findings related to other motivations and influences on young women\u0026rsquo;s premarital decision-making, including pressures from community members, and misconceptions around roles and expectations in marriage.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eMarriage decision makers\u003c/h2\u003e \u003cp\u003eFathers are the primary decision makers when it comes to marriage, though other family members, generally mothers or other male relatives, were also mentioned. Young women themselves were occasionally mentioned, but less frequently than other family members.\u003c/p\u003e \u003cp\u003eDecision-making around marriage is not clear-cut. Most young women described the process as follows: a suitor often approaches the young woman\u0026rsquo;s father, who in turn assesses whether the suitor is a good match for his daughter. If they agree, they either discuss the proposition with the young woman directly or speak to other family members, such as the young woman\u0026rsquo;s mother, uncle or brother, who then solicit the young woman\u0026rsquo;s opinion. This tiered approach was frequently described, and rarely did respondents mention disagreeing if all the adult family members approved of the suitor beforehand. In this way, young women reported involvement in decision-making, but the extent to which they were able to refuse suitors was not clear. For example, one participant described, \u003cem\u003e\u0026ldquo;In my father's opinion, the groom was a good person from a conservative family. First, he talked to my mother about it, then she talked to me. After I had prayed and my heart was at peace, I told them of my consent, and thus the decision was made\u0026rdquo;\u003c/em\u003e (Female IDP, Mareb, age 23, married at age 18).This excerpt exemplifies how young women ultimately make the decision to accept the proposals and how they view their roles as well as their family roles in the process. This process appeared to be largely consistent across both child brides and nonchild brides and by displacement status. There were, however, a couple of examples of alternative decision-making processes, such as other family members or the young woman being the critical decision maker, particularly when young women were not displaced. For example, as one participant described, \u0026ldquo;\u003cem\u003eMy brother was the one who stood by me in the matter of my marriage and helped me to convince the parents to agree to it\u003c/em\u003e\u0026rdquo; (Female host community, Aden, age 21, married at age 15).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eMotivations and influences on young women\u0026rsquo;s decision-making around marriage\u003c/h2\u003e \u003cp\u003eWhile qualitative data indicated that child marriages in this context often included consultation with young women, it was evident that their \u0026ldquo;approval\u0026rdquo; was often based on misconceptions around marriage and marriage roles, pressures from their family and the wider community and lack of alternatives to marriage. Frequently, when young women mentioned that they were involved in the decision to get married, their motivations were to either make their families happy or to escape the conditions of the natal household. Several respondents stated that they agreed to marriage in an attempt to pursue a better life. For example, as one young woman mentioned \u0026ldquo;\u003cem\u003eIn my life there was nothing but housework actually, so I preferred marriage\u0026rdquo;\u003c/em\u003e (Female host community, Hadramaut, age 24, married at age 17). Another young woman mentioned \u003cem\u003e\u0026ldquo;My father agreed and I wasn't thinking about marriage, but the harsh conditions in my father's house made me agree.\u0026rdquo;\u003c/em\u003e (Female IDP, Hadramaut, age 24, married at age 18).\u003c/p\u003e \u003cp\u003eNumerous participants among both the IDP and host community groups described social and economic drivers of their own marriages, including from family, customs, traditions, and religion, peers, and pressure regarding a dowry. Many young women noted the pressure that community norms had on their decision to marry. Such women often stated that they accepted proposals to avoid negative perceptions or rumors about them. The fears of negative perceptions or reaching an age where young women are less desirable seem to strongly influence their decisions to accept proposals.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWhen a girl refuses a proposal, women start talking about her badly; they may say that this girl does not have femininity or maybe she is a prostitute, so she rejects marriage proposals. Therefore, I accepted the first proposal because I do not want such nonsense to be said about me.\u003c/em\u003e \u0026ndash; Female IDP, Aden, age 22, married at age 15\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eEconomic drivers and related factors, such as dowries, were mentioned occasionally both among host community participants and IDP participants. For instance, one respondent stated, \u0026ldquo;\u003cem\u003eMy father wanted to marry me off so that I could ease the burden on him, as he was in poor financial condition,\u0026rdquo;\u003c/em\u003e (Female host community, Aden, age 15, married at age 14). Traditionally, the groom\u0026rsquo;s family offers a dowry to the bride\u0026rsquo;s family to use on wedding expenses. A couple of respondents also mentioned protection as a reason for marriage and how it is viewed as a justification for child marriage. This view is illustrated in the quote \u0026ldquo;\u003cem\u003eBut if appropriate, the husband is \u0026ldquo;suitable\u0026rdquo; as they say, he would marry even a 15-year-old girl. It\u0026rsquo;s better for her protection they say,\u0026rdquo;\u003c/em\u003e (Female host community, Hadhramaut, age 19, married at age 16).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePremarriage perceptions and readiness for marriage\u003c/h2\u003e \u003cp\u003eMany young women, largely those married before age 18, mentioned that they were not aware of the responsibilities they would have once they entered into marriage. Several female respondents who were married before 18 years of age remarked that they did not fully understand the responsibilities that came with marriage or other components of marriage, including childbearing. Furthermore, a couple of female IDP participants who were married under 14 years of age described initial fear towards marriage, often citing fear of violence in the home. Both among IDP and host community participants, several respondents implied a reality in marriage different than expected. As one participant stated: \u003cem\u003e\u0026ldquo;My dreams about marriage have portrayed it as a life of happiness without consequences\u0026rdquo;\u003c/em\u003e (Female IDP, Mareb, age 23, married at age 18). Similarly, one participant remarked \u003cem\u003e\u0026ldquo;I thought of marriage as a simple thing without troubles\u0026rdquo;\u003c/em\u003e (Female IDP, Mareb, age 16, married at age 15).\u003c/p\u003e \u003cp\u003eThere was not a discernable difference between the IDP and host community in terms of perceived or reported readiness to be married; however, differences did appear by age at marriage. Among those who married at age 14 or younger, the vast majority reported not being ready for marriage given their young age. Many reported not knowing or understanding all that would be involved in marriage. Some respondents reported being excited about the wedding and white dress without seeming to understand expectations of marriage more deeply. Regardless of personal readiness, however, respondents discussed how marriage, even at young ages, is the norm in their society.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I felt that I was psychologically ready for marriage. It is normal for me to get married at this age, especially since it is the safe age for marriage. I was happy that I would live a new life\u0026rdquo;\u003c/em\u003e \u0026ndash; Female IDP, Hadhramaut, age 20, married at age 18\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;No, I wasn't ready at all. I was still young. But I was so excited about the white dress and the bridal stuff I was going to get.\u0026rdquo;\u003c/em\u003e \u0026ndash; Female IDP, Aden, age 21, married at age 14\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eImpact of conflict and displacement on marriage decision-making\u003c/h2\u003e \u003cp\u003eIDP respondents were split between whether conflict and displacement affected decisions around marriage or the timing of their marriages. While not directly mentioning decision-making processes, reasons that conflict and displacement did affect marriage timelines were often stated simultaneously with the idea of marriage being up to \u0026ldquo;fate\u0026rdquo; and \u0026ldquo;god\u0026rsquo;s will\u0026rdquo;. Participants did not seem to differentiate between the effects of conflict and displacement, viewing them as indistinguishable. Several respondents also mentioned that the conflict would have changed the decision to marry, because they would have stayed in school.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eMarriage was not going to change, whether before or after the war. Marriage before the war was better in terms of providing the requirements and preparing the bride, but in terms of marriage, I would get married sooner or later any way.\u003c/em\u003e \u0026ndash; Female IDP, Hadhramaut, age 23, married at age 14\u003c/p\u003e\u003cp\u003e \u003cem\u003eIf there hasn\u0026rsquo;t been war, I would have continued my study. Regarding marriage, if my destiny wanted, it would happen.\u003c/em\u003e \u0026ndash; Female IDP, Marib, age 22, married at age 19\u003c/p\u003e\u003cp\u003e \u003cem\u003eI did not complete my study due the conflict, and even if I hadn\u0026rsquo;t completed my study, I would get married at an elder age.\u003c/em\u003e \u0026ndash; Female IDP, Aden, age 20, married at age 17\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHost community respondents were also split on whether the conflict had an impact on their marriage decisions. Of those that responded in the affirmative, most indicated that they would have been married later if not for the conflict. Women who indicated that they would have been married later stated that they would have continued their education.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eYes, I would have got married a little later and completed my university studies. But because of the war, I was convinced that there was no use in education as long as I could not find a job.\u003c/em\u003e \u0026ndash; Female host community, Aden, age 23, married at age 17\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe find that young women reported a relatively high level of decision-making surrounding marriage, though involvement was significantly lower for those who married before age 18 and for those who were displaced. Qualitative data complicate this understanding by highlighting both the complex process through which proposals are made and the constrained context in which young women make decisions\u0026mdash;marked by social norms supporting child marriage, limited educational and economic opportunities, and challenging conditions in their natal homes.\u003c/p\u003e \u003cp\u003eIn our study, 71% percent of young women said they were either completely or very involved in the decision to marry, indicating a high degree of reported involvement. We did find lower decision-making for those who were married before age 18, but findings from this study add nuance to the dominant child marriage discourse that child brides are unaware and forced into their marriages without personal involvement.(25,30) Specifically, the qualitative data highlight that while involvement in the marriage decision process is common, such involvement may not reflect complete agency or autonomy in decision-making around marriage. Young women are often asked to consent to marriage after a father or other elder or relatively have already decided that a marriage should take place. Qualitative results also highlight that child brides reported lower readiness to be married and were less aware of the responsibilities of marriage. Thus, their involvement may be mostly superficial, and though young women may report decision-making involvement, such involvement may not be a demonstration of true autonomy. These findings raise questions about young women\u0026rsquo;s ability to exercise full decision-making over their marriages when they may not fully comprehend the choices presented to them and face a significant lack of viable alternatives for pathways to adulthood and social and familial pressure to conform.\u003c/p\u003e \u003cp\u003eOur study findings highlight the need to more clearly understand how to define autonomy and agency in marriage and how such a construct applies to contexts in which young women are choosing marriage to escape harsh conditions or are without alternative options. Starting with the definition of Ahearn in which agency refers to \u0026ldquo;the socioculturally mediated capacity to act,\u0026rdquo; we can consider agency in the decision to marry as the capacity to act and make decisions around marriage.(31) Murphy-Graham and Leal expand on this thinking to apply the concepts of \u0026ldquo;thin\u0026rdquo; and \u0026ldquo;thick\u0026rdquo; agency to child marriage, in which thin agency refers to marriage decisions made in highly restrictive contexts, whereas thick agency refers to decision-making with a wider availability of options.(32)\u003c/p\u003e \u003cp\u003eOur qualitative findings support the widespread presence of what has been described in the literature as \u0026ldquo;thin\u0026rdquo; agency in which decisions are made under considerable pressure from intersecting structural constraints. Such constraints include entrenched gender norms that normalize child marriage, restricted access to formal education and labor markets, household environments that are unstable, and households marked by economic insecurity or gendered expectations around obedience and pronatalism. These findings align with research among Syrian refugees, which also found that young women felt pressure to consent to marriage due to a lack of alternatives and other opportunities.(33)\u003c/p\u003e \u003cp\u003eEfforts to eliminate child marriage globally must engage more critically with the realities of such constrained agency and the gender and social systems that result in \u0026ldquo;thin\u0026rdquo; choices. Framing child marriage solely as a matter of individual choice or awareness is insufficient; rather, interventions must confront the broader sociocultural and economic systems that systematically narrow the scope of options available to adolescent girls and young women. Addressing the root causes of \u0026ldquo;thin\u0026rdquo; agency requires sustained efforts to transform the gendered social structures, economic vulnerabilities, and normative frameworks that shape girls\u0026rsquo; trajectories from a young age.\u003c/p\u003e \u003cp\u003eIn this context, deepening young women\u0026rsquo;s ability to exercise what has been termed \u0026ldquo;thick\u0026rdquo; agency must be seen as a central goal of child marriage prevention. This is particularly urgent given robust evidence that greater autonomy and decision-making power among women and girls are closely linked to an array of improved reproductive health outcomes, including contraceptive uptake, prenatal care, and antenatal service.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eEfforts to deepen agency and address systemic barriers to alternatives to marriage are particularly important for displaced young women. The global community is currently failing to build this population\u0026rsquo;s agency, as governments often do not view child marriage as an urgent issue or as one on which they can make a substantial impact.(2,32) Interventions should aim to change the underlying conditions that make marriage an appealing solution. Young women noted that viable alternatives to marriage, specifically education and labor activities, were impacted by conflict and displacement, both for displaced and host communities, thereby restricting the degree of full agency in marriage that they have. Such disruptions are typical of complex humanitarian emergencies, but education and employment are also the most effective means to prevent child marriage by providing alternative means for economic security and shifting gender norms around expected roles of women.(12,29,34) While humanitarian response in emergencies must prioritize restoring safety and security, in the longer term, response efforts must not neglect the restoration of education and labor opportunities and ensure that these are available to both males and females. Providing young women with greater access to meaningful opportunities through education and employment can cultivate their aspirations, enabling them to see themselves as more than wives, and increase their understanding of health relationships.\u003c/p\u003e \u003cp\u003eOn the whole, a more comprehensive understanding of the practice of early and child marriage is essential given that international terminology and norms are evolving, and researchers are acknowledging that both marriage and girlhood mean different things across the world.(35) As Giaquinta writes, while \u0026ldquo;international development organizations acknowledge children have the capacity to participate and make decisions about certain [things] like their educational experience, they continue to refute the idea that youth possess the sexual agency and maturity to consent to marriage and thus justify the need to control young women\u0026rsquo;s sexual bodies through interventions to end child marriage\u0026rdquo;.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) At the same time, ascertaining how much coercion and familial roles are present in the process provides public health practitioners with insight into better research priorities and programming to address forced child marriages. Future research should further examine how societal context and social norms influence autonomy in marriage decision-making and its consequences for young women and men.\u003c/p\u003e \u003cp\u003eThese findings should be considered in light of some limitations. There was only one question on decision-making, which may not offer an adequate and full representation of the construct of autonomy and choice, as indicated by the qualitative data. More research is needed to improve the measurement of autonomy and decision-making for young women, particularly in the context of constrained choice. In addition, the question was not asked of those who were not married; young women with more decision-making power may have exercised that choice and not gotten married, thus introducing selection bias into our sample. Nonetheless, our results indicate that among those who were married, decision-making does vary by age at marriage and displacement status, findings that are further supported by the qualitative data. Finally, given the highly contextualized nature of conflict, it is difficult to ascertain how much of this analysis can be generalized to other settings. The strengths of this study include that it was conducted during an active humanitarian emergency. The research team was able to survey a large study sample and collect data on a comprehensive set of independent factors to test associations with decision-making. Additionally, this analysis offered the unique perspective of assessing decision-making in child marriage as opposed to factors associated with the marriage itself, in an attempt to gain a more nuanced understanding of the experience. Furthermore, the use of both quantitative and qualitative data adds a nuanced understanding of young women\u0026rsquo;s decision-making power around marriage in humanitarian settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study assessed the association between premarital decision making and age of marriage among married young women in Yemen. The results indicate that while most young women state that they were involved in the decision to marry, involvement in premarital decision-making was significantly lower for young women who marry before 18 years of age and for displaced young women. In addition, while most young women do state that they have autonomy in the decision to marry, it is unclear to what extent this is true given the number of people and other external factors influencing their decision. By using premarital decision-making as the outcome of interest, this research attempted to better assess young women\u0026rsquo;s relationship with and opinions of marriage in view of their own life experiences. Research on autonomy in marriage decisions has implications for how the global community views and continues to research marriage decision-making in humanitarian settings in the future.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCEFM: child, early, and forced marriage\u003c/p\u003e\n\u003cp\u003eCI: confidence interval\u003c/p\u003e\n\u003cp\u003eEMEC: Early Marriage and Early Childbearing project\u003c/p\u003e\n\u003cp\u003eIDI: in-depth interview\u003c/p\u003e\n\u003cp\u003eIDP: internally displaced person\u003c/p\u003e\n\u003cp\u003eR2HC: Research for Health in Humanitarian Crises programme\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData collection was approved by the Institutional Review Board of the Johns Hopkins Bloomberg School of Public Health [Ref Number 21168] and the Yemen IRB, the Ethical Review Board of the Ministry of Health. Both review boards approved informed verbal consent/assent to be obtained from study participants, as many participants were from rural areas and were not able to read and write.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe obtained verbal consent from unmarried participants aged 18 years old and older and married girls aged 15\u0026ndash;17 years old who were considered emancipated minors in this context. For unmarried girls aged 15-17, verbal assent coupled with oral permission from their parent/guardian was used.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the authors upon reasonable request and with the permission of Norwegian Social Research (NOVA). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;This research project is funded by Elrha\u0026rsquo;s Research for Health in Humanitarian Crises (R2HC) programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome, and the Department for Health and Social Care (DHSC) through the National Institute for Health Research (NIHR).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCG conducted final quantitative and qualitative data analysis and prepared the final draft of the manuscript. HT conducted the quantitative data analysis and initial qualitative data analysis and drafted sections of the manuscript. CG and HT contributed equally and share first authorship. TA, AA, and AAK led the local data collection, contributed to interpretation, and participated in the development of the manuscript. BA, CR, LZ, and SE designed and conceptualized the study, provided oversight during its implementation, and provided feedback on the manuscript. LZ and SE oversaw the data analysis and manuscript development. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eChild marriage | UNICEF [Internet]. [cited 2025 May 21]. Available from: https://www.unicef.org/protection/child-marriage\u003c/li\u003e\n \u003cli\u003eMazurana D, Marshak A, Spears K. International Review of the Red Cross. 2019 [cited 2025 May 21]. Child marriage in armed conflict. Available from: http://international-review.icrc.org/articles/child-marriage-armed-conflict\u003c/li\u003e\n \u003cli\u003eCentral Statistical Organization (CSO) and United Nations Children\u0026rsquo;s Fund (UNICEF). Yemen Multiple Indicator Cluster Survey 2022-2023, Survey Findings Report [Internet]. Yemen: Central Statistical Organization and United Nations Children\u0026rsquo;s Fund; 2023 [cited 2025 May 21]. 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PLOS ONE. 2020 Jul 17;15(7):e0235959.\u003c/li\u003e\n \u003cli\u003eElnakib S, Elsallab M, Wanis MA, Elshiwy S, Krishnapalan NP, Naja NA. Understanding the impacts of child marriage on the health and well-being of adolescent girls and young women residing in urban areas in Egypt. Reproductive Health. 2022 Jan 15;19(1):8.\u003c/li\u003e\n \u003cli\u003eDadras O, Khampaya T, Nakayama T. Child Marriage, Reproductive Outcomes, and Service Utilization among Young Afghan Women: Findings from a Nationally Representative Survey in Afghanistan. Studies in Family Planning. 2022;53(3):417\u0026ndash;31.\u003c/li\u003e\n \u003cli\u003eGirls Not Brides [Internet]. [cited 2025 May 21]. About child marriage. 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Journal of Adolescent Health. 2021 Dec 1;69(6, Supplement):S13\u0026ndash;22.\u003c/li\u003e\n \u003cli\u003ePresler-Marshall E, Jones N, Alheiwidi S, Youssef S, Hamad BA, Odeh KB, et al. Through their eyes: exploring the complex drivers of child marriage in humanitarian contexts [Internet]. GAGE. 2020 [cited 2025 May 21]. Available from: https://www.gage.odi.org/publication/through-their-eyes-exploring-the-complex-drivers-of-child-marriage-in-humanitarian-contexts/\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\u003eChild Marriage in the Middle East and North Africa \u0026ndash; Yemen Country Brief [Internet]. United Nations Children\u0026rsquo;s Fund (UNICEF) Middle East and North Africa Regional Office in collaboration with the International Center for Research on Women (IRCW); 2017 [cited 2025 May 21]. Available from: https://www.unicef.org/mena/media/1821/file/%20MENA-CMReport-YemenBrief.pdf.pdf\u003c/li\u003e\n \u003cli\u003eMazurana D, Marshak. Addressing Data Gaps on Child Marriage in Humanitarian Settings [Internet]. [cited 2025 May 21]. Available from: https://fic.tufts.edu/publication-item/data-gaps-child-marriage-in-humanitarian-settings/\u003c/li\u003e\n \u003cli\u003eGirls Not Brides. Girls Not Brides. [cited 2025 May 21]. Child marriage atlas - Girls Not Brides. Available from: https://www.girlsnotbrides.org/learning-resources/child-marriage-atlas/atlas/yemen/\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\u003eDe-Juanas \u0026Aacute;, Bernal Romero T, Goig R. The Relationship Between Psychological Well-Being and Autonomy in Young People According to Age. Front Psychol [Internet]. 2020 Dec 10 [cited 2025 May 21];11. Available from: https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.559976/full\u003c/li\u003e\n \u003cli\u003eCrandall A, VanderEnde K, Cheong YF, Dodell S, Yount KM. Women\u0026rsquo;s age at first marriage and postmarital agency in Egypt. Social Science Research. 2016 May 1;57:148\u0026ndash;60.\u003c/li\u003e\n \u003cli\u003eBloom SS, Wypij D, Das Gupta M. Dimensions of women\u0026rsquo;s autonomy and the influence on maternal health care utilization in a north Indian city. Demography. 2001 Feb;38(1):67\u0026ndash;78.\u003c/li\u003e\n \u003cli\u003eFuruta M, Salway S. Women\u0026rsquo;s Position Within the Household as a Determinant Of Maternal Health Care Use in Nepal. International Perspectives on Sexual and Reproductive Health. 2006 Mar 1;32:17.\u003c/li\u003e\n \u003cli\u003eWoldemicael G. Do Women With Higher Autonomy Seek More Maternal Health Care? Evidence From Eritrea and Ethiopia. Health Care for Women International. 2010 Jun 10;31(7):599\u0026ndash;620.\u003c/li\u003e\n \u003cli\u003eGiaquinta B. Silenced subjectivities \u0026amp; missed representations: Unpacking the gaps of the international child marriage discourse. In 2016 [cited 2025 May 21]. Available from: https://www.semanticscholar.org/paper/Silenced-subjectivities-%26-missed-representations%3A-Giaquinta/b296a083eeac20da29c52a858a9842510c302d5c\u003c/li\u003e\n \u003cli\u003eConflict in Yemen and the Red Sea | Global Conflict Tracker [Internet]. [cited 2025 May 21]. Available from: https://www.cfr.org/global-conflict-tracker/conflict/war-yemen\u003c/li\u003e\n \u003cli\u003eWorld Bank. Macro Poverty Outlook for Yemen, Republic of : October 2024 [Internet]. Washington, DC: World Bank Group; 2024 Oct [cited 2025 May 22]. (Macro Poverty Outlook (MPO)). Report No.: 194058. Available from: http://documents.worldbank.org/curated/en/099626510152416893\u003c/li\u003e\n \u003cli\u003eYemen | Annual DTM Report on Displacement 2023 [Internet]. International Organization for Migration; 2024 [cited 2025 May 21]. Available from: https://dtm.iom.int/sites/g/files/tmzbdl1461/files/reports/20240207_YEMEN%20-%20Annual%20DTM%20Report%20for%20Displacement%202023_1_0.pdf?iframe=true\u003c/li\u003e\n \u003cli\u003eMalhotra A, Elnakib S. Evolution in the Evidence Base on Child Marriage 2000\u0026ndash;2019 [Internet]. UNFPA-UNICEF Global Programme to End Child Marriage; 2021 Jan [cited 2025 May 21]. Available from: https://www.unicef.org/media/91991/file/Child-marriage-evidence-report-2021.pdf\u003c/li\u003e\n \u003cli\u003eSave the Children [Internet]. 2020 [cited 2025 May 21]. Child Marriage: A Violation of Child Rights. Available from: https://www.savethechildren.org/us/charity-stories/child-marriage-a-violation-of-child-rights\u003c/li\u003e\n \u003cli\u003eAhearn LM. Language and Agency. Annual Review of Anthropology. 2001 Oct 1;30(Volume 30, 2001):109\u0026ndash;37.\u003c/li\u003e\n \u003cli\u003eMurphy-Graham E, Leal G. Child Marriage, Agency, and Schooling in Rural Honduras. Comparative Education Review. 2015 Feb;59(1):24\u0026ndash;49.\u003c/li\u003e\n \u003cli\u003eZuntz AC, Palattiyil G, Amawi A, Al Akash R, Nashwan A, Al Majali A, et al. Early marriage and displacement\u0026mdash;a conversation: how Syrian daughters, mothers and mothers-in-law in Jordan understand marital decision-making. The British Academy [Internet]. 2021 Jul 15 [cited 2025 May 21]; Available from: https://www.thebritishacademy.ac.uk/publishing/journal-british-academy/9/early-marriage-and-displacement/\u003c/li\u003e\n \u003cli\u003eMalhotra A, Elnakib S. 20 Years of the Evidence Base on What Works to Prevent Child Marriage: A Systematic Review. Journal of Adolescent Health. 2021 May 1;68(5):847\u0026ndash;62.\u003c/li\u003e\n \u003cli\u003eEfevbera Y, Bhabha J. Defining and deconstructing girl child marriage and applications to global public health. BMC Public Health. 2020 Dec;20(1):1\u0026ndash;11.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Child marriage, Marriage decision-making, Agency, Conflict, Humanitarian settings, Adolescent health, Middle East, Yemen, Sexual and reproductive health","lastPublishedDoi":"10.21203/rs.3.rs-6762440/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6762440/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e. Although the rate of child, early, and forced marriage (CEFM) has decreased over the last decade, one in five girls globally will still be married before age 18. While research has identified drivers of child marriage, less attention has been paid to understanding the involvement of young women themselves in the process of marriage, including their decision-making and potential motivations to marry when living in humanitarian settings characterized by poverty and limited opportunities. This study uses quantitative and qualitative data to explore factors associated with perceived involvement in decision-making at time of first marriage among young women in Yemen.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e. The data for this study come from the Early Marriage Early Childbearing (EMEC) study, which was conducted in 2022 in the governorates of Aden, Hadramout, and Ma’arib. This analysis uses data from 991 quantitative surveys and 47 in-depth interviews with married young women. We use logistic regression to examine the association between child marriage and autonomy in decision-making around marriage. We then conduct thematic analysis of in-depth interviews to examine decision-making processes and motivations in marriage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e. \u0026nbsp;Among the 991 ever-married female respondents, approximately 55% were married before 18 years of age and half had been displaced. After controlling for covariates, child marriage and displacement status were significantly associated with reduced involvement in marital decision-making. Child brides had 85% greater odds of reporting little or no involvement in the decision to marry than did those married at age 18 or older, and displaced young women had 36% greater odds than did those not displaced. Qualitative data illustrate the significant familial and social pressures that girls and young women face to accept proposals and the diverse understandings of what marriage readiness entails.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e. We find that young women report a relatively high level of decision-making surrounding marriage, although involvement was significantly lower for those who married before age 18 and for those displaced. The qualitative data highlight that despite such reported involvement, girls live within contexts of limited choice, including norms that support child marriage, lack of educational or labor opportunities, and challenging conditions in the home.\u003c/p\u003e","manuscriptTitle":"Consent and Conflict: Factors Associated with Premarital Decision-Making for Young Women in Conflict-Affected Settings in Yemen","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 11:38:31","doi":"10.21203/rs.3.rs-6762440/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4346af21-bc70-43e3-939a-3aae935f7f0f","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-18T23:53:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-18 11:38:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6762440","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6762440","identity":"rs-6762440","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}