Journal of Adolescent Health 64 (2019) S37eS44

www.jahonline.org

Original article

Measuring Social Norms Related to Child Marriage Among Adult

Decision-Makers of Young Girls in Phalombe and Thyolo, Malawi
Mara Steinhaus, M.S.P.H. *, Laura Hinson, Ph.D., M.P.H., A. Theodore Rizzo, M.A., and
Amy Gregowski, M.H.S.
International Center for Research on Women, Washington, DC

Article history: Received May 16, 2018; Accepted December 11, 2018
Keywords: Social norms; Measurement; Child marriage; Malawi; Adolescents; Sexuality

A B S T R A C T
IMPLICATIONS AND
CONTRIBUTION
Purpose: Given the importance of developing appropriate measures for assessing social norm
change, this article documents the process, results, and lessons learned from a baseline survey
This article applies
measuring social norms related to child marriage in Phalombe and Thyolo districts in Southern rigorous social norm the-
Malawi. ory and measures to offer
Methods: A quantitative questionnaire was administered to a representative sample of all adults learnings that can both
(age
18 years) who self-identified as a decision-maker for at least one girl between the ages of 10 inform program design to
and 17 years, for a total sample size of 1,492 respondents. Measures of empirical expectations, prevent child marriage in
normative expectations, and sanctions related to child marriage were modeled after previously Malawi and improve the
developed measures and social norm theory. quality of social norms
Results: Using an established social norm diagnostic process, this study found that, despite research related to child
Southern Malawi having the lowest median age of first marriage in the country, child marriage marriage globally.
may not be a strong social norm in the intervention communities. Specifically, although 89.3% of
respondents expressed the empirical expectation that “Most girls in this community marry before
the age of 18,” agreement with the normative expectation that “Most people in this community
expect girls to marry before the age of 18” was just 53.2% overall and fear of sanctions was just
36.4%.
Conclusions: Taken together, the presence of prudential reasons for child marriage and the weak
evidence of normative expectations and sanctions indicate that child marriage may not be a social
norm in these communities although it may be indirectly perpetuated by other norms related to
adolescent sexuality and access to contraception.
Ó 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open
access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Child marriage, defined as marriage before the age of 18 years,

is a human rights violation so widely acknowledged that its
Conflicts of interest: The authors have no conflicts of interest to disclose.
Disclaimer: The publication of this article was made possible by the support of complete elimination by 2030 was included among the Sus-
the Bill & Melinda Gates Foundation. The opinions or views expressed in this tainable Development Goals, which were adopted by more than
article are those of the authors and do not necessarily reflect the views of the Bill 190 countries in 2015 [1]. Success of this bold endeavor in such a
& Melinda Gates Foundation. short time will hinge on prevention programs’ abilities to rapidly
* Address correspondence to: Mara Steinhaus, M.S.P.H., International Center
for Research on Women, 1120 20th Street NW, Suite 500N, Washington,
assess and act to change the factors perpetuating child marriage
DC 20036. in the diverse locations where it exists. To that end, the devel-
E-mail address: [email protected] (M. Steinhaus). opment community has recently taken an interest in

1054-139X/Ó 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access article under the CC BY license (http://
creativecommons.org/licenses/by/4.0/).
https://doi.org/10.1016/j.jadohealth.2018.12.019
S38 M. Steinhaus et al. / Journal of Adolescent Health 64 (2019) S37eS44

understanding the role that social norms play in perpetuating and the Girls Empowerment Network of Malawi. ENGAGE seeks to
child marriage, believing they may represent a missing piece of empower girls and civil society organization (CSO) leaders to shift
the puzzle critical to prevention [2e4]. This interest in social attitudes and social norms around child marriage and increase
norms related to child marriage coincides with a burgeoning gender equity. The quasi-experimental, four-arm evaluation will
research field dedicated to measuring the presence and strength allow for the comparison of the effectiveness of the different
of social norms, raising new insights and questions about when interventionsdempowering girls only, building the capacity of
and how norms drive human behavior [5,6]. This article docu- CSOs only, or the combination of bothdagainst a comparison site
ments the process, results, and challenges from a quantitative where no intervention will take place. This article focuses on the
survey that measured social norms related to child marriage in measurement of social norms related to child marriage in the
Malawi’s Phalombe and Thyolo districts. implementation communities using data from the cross-sectional
As of the most recent Demographic and Health Survey, con- baseline survey conducted from May to August 2017.
ducted in Malawi in 2015, 42% of women aged 20e24 married
before the age of 18 years [7]. Phalombe and Thyolo are located in Methods
Malawi’s Southern region, where the median age at first mar-
riage and median age at first sex are the lowest in the country, at Intervention site selection
17.9 years and 16.4 years, respectively [7]. Malawi’s government
has recently enacted laws to end child marriage at a national To select the intervention sites, the ENGAGE team restricted
level. In 2015, parliament passed a law that banned marriage their search to districts in Southern Malawi with few child mar-
before the age of 18 years and, in April 2017, the exception riage interventions. After visiting these districts, the team selected
allowing child marriage with parental consent was removed [8]. Phalombe and Thyolo as the two districts most comparable on
Despite this progress, it is uncertain whether administrators are relevant characteristics, using available statistics related to child
enforcing these laws at local levels. marriage and interviews with key governmental and community
Previous work exploring reasons for child marriage in Malawi stakeholders. Both arms including the CSO intervention were a
found that most young women married because of poverty and, priori assigned to Thyolo, the district with the fewest resources.
to a lesser extent, unplanned pregnancy [9], while education Within each district, the arms were then randomly assigned to
plays a protective role in delaying age at first marriage [10]. These traditional authorities (TAs), the geographic division below the
findings are consistent with findings from other contexts in sub- district level in Malawi, excluding TAs that were atypical or too
Saharan Africa and South and Southeast Asia [3,11e15]. However, challenging for program implementation. Ultimately, in Thyolo
few studies have explored the role that social norms play driving District, TA Changata was assigned both the girls and CSO inter-
child marriage using rigorous social norm theory and measures. vention, and TA Mchiramwera was assigned the CSO-only inter-
By applying these measures, we can better understand how so- vention. In Phalombe, TA Chiwalo was assigned the girls-only
cial norms are related to child marriage in Malawi and inform intervention, and TA Nazombe was designated as the comparison
program approaches to address and prevent child marriage. site. A map of the selected TAs is shown in Figure 1.
There is no universally accepted definition of social norms and
no standard methodology for quantifying their presence and Sample
strength [5]. However, many organizations have recently based
their social norms measurement work on theory developed by the Quantitative questionnaires were administered to a represen-
University of Pennsylvania Social Norms Group, led by Dr. Cristina tative sample of 1,492 adults who self-identified as a decision-
Bicchieri [16]. According to this theory, a minimum of the following maker for at least one girl between the ages of 10 and 17 years.
must be measured to assess the presence of a social norm: The sampling for baseline data collection followed a two-stage
sampling design. First, 15 villages were randomly selected in
1. Behavior: what individuals do; each TA with probability proportional to size. Then, 25 eligible
2. Prudential reasons: reasons for a behavior that do not depend households were randomly selected within each village. House-
on social expectations; holds were considered eligible if they contained any individual
3. Empirical expectations: what individuals believe others do; eligible for the survey. Individuals were considered eligible if they
4. Personal normative beliefs: what individuals believe should be were aged 18 years or above, had lived in the community for at
done; and least 1 year, and self-identified as a decision-maker for at least one
5. Normative expectations: what individuals believe others think girl between the ages of 10 and 17 years. Finally, one eligible
they should do. household member was randomly selected to be interviewed,
without respect to the gender of the individual. If the randomly
In each case, the “others” in question are an individuals’ selected individual did not consent to be interviewed, they were
reference group, defined as those people whose opinions matter replaced by another eligible individual in their household. If the
to the individual. In addition, the strength of norms can be selected household member was not home, enumerators made
assessed through measures of sanctions, the social consequences three visits to attempt to interview that person before replacing
(positive or negative) of an action. One of the leading organiza- them with another member of the household. If an entire
tions working on translating Bicchieri’s social norm theory into household was not home after three visits or if no eligible indi-
measures for informing and evaluating development in- vidual in the household consented to participate in the study, it
terventions is CARE, which since 2014 has tested and refined was replaced with the next household on the randomized list.
social norms measures in several projects [6]. Before the start of data collection, enumerators completed a 1-
The International Center for Research on Women (ICRW) is the week training facilitated by two ICRW staff members covering
evaluation partner for the Enabling Girls to Advance Gender Eq- topics including research ethics, the study purpose and method-
uity (ENGAGE) project, which is being implemented by Rise Up ology, a question-by-question review of the tool, including review
 M. Steinhaus et al. / Journal of Adolescent Health 64 (2019) S37eS44 S39

closest topical fit to the present study. The measures of empirical

and normative expectations were used almost verbatim,
whereas the measure of sanctions was refined in conversation
with the ENGAGE project’s local implementation team to relate
specifically to what they perceived as the most common social
sanction for families that failed to marry their daughters young
in these communitiesdloss of respect.
Behaviors related to child marriage were assessed by asking
respondents about their past decisions and intentions for one
unmarried or recently married girl aged 10 to 17 years, called the
“reference girl.” To select the reference girl, participants were
asked to complete a roster of all unmarried or recently married
girls of that age under their decision-making influence. They
were then asked to identify the girl over whom they had the
most decision-making influence, who was used as the reference
girl during that module of the interview.
Personal normative beliefs were assessed by measuring
agreement with the statement “it is wrong to marry a girl before
the age of 18” and other related questions about personal opinions
of whether a girl should have a say in when and whom to marry.
Questions about prudential reasons for child marriage were
asked as part of Plan International’s Child Marriage Acceptability
score, a 23-item score developed in 2015 to assess child marriage
acceptability at the individual level that had previously been
adapted to the Malawian context by KIT Health as part of their
Yes I Do project [18,19]. The five individual questions used to
assess prudential reasons for child marriage include statements
such as “Marrying girls at a young age can help provide them
security” and “Marrying girls young can help prevent sexual
violence, assault, and harassment.”
In addition to data collected as part of the questionnaire,
enumerators were asked to document their own observations of
relevant information about local child marriage bylaws or in-
terventions that they opportunistically observed in the field.

Figure 1. Map of Malawi showing the four selected TAs. Analyses

of the accuracy of the translation, and piloting. During data All statistical analyses were conducted in Stata 14.0 (Stata-
collection, enumerators sought informed consent after ensuring Corp. 2015. Stata Statistical Software: Release 14. College Station,
individual eligibility and before beginning the interview. In- TX).
terviews were conducted in a location where privacy could To assess the presence of a social norm related to child marriage,
reasonably be expected, out of earshot of other family members. descriptive statistics for each component of the norms measures
Informed consent and the surveys were administered in the local were calculated. Chi-squared tests for significant differences by
language, Chichewa, with translated survey instruments. Data gender and simple logistic regression to test for differences by age
were collected on tablets, and no identifiable information was were performed on key outcome variables. Then, the structured
collected. At the end of each day, all data collectors submitted their diagnostic process established by Bicchieri et al. [16] was followed,
tablets to the field supervisor, who uploaded the data to a secure as explained in more detail in the Results section. When these
laptop and backed up all data onto an online, secure server. The results suggested that child marriage may not be a social norm,
tablets, laptops, and server were all password-protected, and the opportunistically collected contextual information was reviewed to
passwords were only known to members of the study team. Ethical hypothesize explanations for this unanticipated result. Other data
approval of the research protocol and tools was obtained from from the survey, particularly data on decision-makers’ attitudes
both the Institutional Review Board of ICRW and Malawi’s National toward adolescent sexuality, were also analyzed to inform
Commission for Science and Technology. alternative explanations for child marriage in these communities of
Malawi. Unfortunately, although analyses linking these potential
Measures factors with behavioral outcomes were planned, very few (<2.0%)
adults selected reference girls who had ever been married,
The social norms measures were based on previously estab- rendering this line of investigation inadvisable.
lished measures and social norms theory [16,17]. As shown in
Table 1, in this study, measures of social expectations and sanc- Results
tions related to child marriage were adapted from measures
developed for CARE’s Abdiboru project in Ethiopia, which aims to Sample characteristics are shown in Table 2. Most re-
reduce marriage among young adolescent girls and was the spondents were parents, grandparents, or adult siblings of their
S40 M. Steinhaus et al. / Journal of Adolescent Health 64 (2019) S37eS44

reference girl. The sample obtained was about 73% female

Most people in this community expect girls to marry before

early, my family will not be respected in the community

If I do not ensure my daughters and/or nieces are married
overall, most heavily in Mchiramwera at 84%. This was largely a

Agree a lot; Agree a little; Disagree a little; Disagree a lot

Agree a lot; Agree a little; Disagree a little; Disagree a lot

Agree a lot; Agree a little; Disagree a little; Disagree a lot

Most girls in this community marry before the age of 18
result of the selection criteria; men were often away from home
working for several weeks and therefore were considered ineli-
gible as they were not currently in residence at the household.
Respondents ranged in age from 18 to 92 years, with a median
age of 37 years. Overall, most respondents had completed pri-
mary school but not beyond (63.9%), whereas about one in four
(23.5%) had no formal education. Just one in eight (12.6%) had
completed secondary education or higher. Overall, about 62% of
respondents had paid employment within the past year.
ICRW’s ENGAGE measure

Compared with male respondents, female respondents had

significantly lower educational attainment (b¼ e.9, p ¼ .000) and
Response options:

Response options:

Response options:
were significantly less likely to have had paid employment in the
the age of 18

past year (odds ratio ¼ .7, p ¼ .004).

Responses to the measures required to assess whether child
Question:

Question:

Question:

marriage is a social norm are shown in Table 3. We found very

high empirical expectations in all four sites; almost 9 in 10 adult
decision-makers (89.3%) agreed that most girls in their com-
Agree a lot; Agree a little; Disagree a little; Disagree a lot

Agree a lot; Agree a little; Disagree a little; Disagree a lot

Agree a lot; Agree a little; Disagree a little; Disagree a lot

Most people in the community expect adolescent girls to

munity marry before the age of 18 years. However, there was less
evidence of normative expectations and even less evidence of
Most adolescent girls marry before the age of 17

sanctions across most sites. Agreement with the normative

expectation that “Most people in this community expect girls to
get married before the age of 17 years

marry before the age of 18” was 53% overall and did not vary
significantly by age or gender. Agreement with the statement
Marrying early avoids social stigma
CARE’s Abdiboru project measure

about sanctions, “If I do not ensure my daughters and/or nieces

are married early, my family will not be respected in the
community,” was 36% overall and decreased slightly but
significantly with age (odds ratio ¼ 0.99; no significant difference
Comparative table of measures used to assess the presence and strength of social norms related to child marriage

by gender).
Response options:

Response options:

Response options:

These results were cross-checked with contextual informa-

ENGAGE ¼ Enabling Girls to Advance Gender Equity; ICRW ¼ International Center for Research on Women.

tion observed by the study team during data collection. They

Question:

Question:

Question:

documented many instances of intervention by local leaders

against child marriage. For example, just as data collection was
starting, the District Executive Council for Phalombe adopted
district-wide laws setting the age of marriage at 21 years for men
40 years old, how many think that it is good that
Out of 100 men in your community who are at least
25 years old in your community. Out of 100 such

girls get married before they are 18 years old?

and 18 years for women and officially annulling all marriages

Think about married women in between 18 and

women, how many do you think got married

that did not meet these criteria. Several village chiefs in both
districts had also set by-laws with higher ages of marriage and
were breaking up marriages involving girls. In Thyolo, several
village groups had instituted laws where men who married or
before they were 18 years old?

impregnated women below the age of 18 years or their families

Bicchieri’s example measure

were required to pay a fine of money/livestock to the village chief

Number of women 0e100

and other local leaders. However, not all local leaders sanctioned
Number of men 0e100

child marriage, and some had married children themselves.

We then explored alternative explanations for child marriage
Response options:

Response options:

Response options:

in these communities. First, we verified that personal normative

Not provided

Not provided

beliefs were not supportive of child marriage. More than 9 of

Question:

Question:

Question:

every 10 respondents (92.3%) agreed that it is wrong to marry a

girl before the age of 18 years and, similarly, about 95% of adult
decision-makers agreed that a girl should have a say in who she
marries, and nearly 90% agreed that a girl should have a say in
Beliefs about what others expect

Social consequences (positive or

when she marries.

Beliefs about what others do

Then, we explored the possibility that child marriage occurs

Normative expectations

negative) of an action

for prudential reasons. We found little evidence that respondents

Empirical expectations

considered child marriage protective for girls, either by providing

them security (8.0% agreement) or by preventing sexual violence,
assault, or harassment (10.1% agreement). However, many re-
one to do

spondents reported that child marriage sometimes happens for

Sanctions
Concept

financial reasons, and more than three in four (78.2%) reported

Table 1

that child marriage “mostly happens because there is a lack of

education and job opportunities.”
 M. Steinhaus et al. / Journal of Adolescent Health 64 (2019) S37eS44 S41

Table 2
Baseline demographic characteristics of respondents by site, Malawi, 2017

Chiwalo (n ¼ 375) Mchiramwera Changata Nazombe Total

(n ¼ 375) (n ¼ 372) (n ¼ 370) (n ¼ 1,492)

n % n % n % n % n %

Sex
Male 133 35.5 59 15.7 101 27.2 117 31.6 410 27.5
Female 242 64.5 316 84.3 271 72.8 253 68.4 1,082 72.5
Age (y)
Mean 39.0 40.0 43.0 40.9 40.7
Median 35 37 40 38 37
Range 18, 84 18, 92 18, 85 18, 86 18, 92
Respondent’s highest level of education
None 90 24.0 78 20.8 97 26.1 85 23.0 350 23.5
Primary 244 65.1 248 66.1 226 60.8 235 63.5 953 63.9
Secondary 39 10.4 46 12.3 46 12.4 44 11.9 175 11.7
Higher 2 .5 3 .8 3 .8 6 1.6 14 .9
Paid employment, past 12 mo
No 165 44.0 113 30.1 135 36.3 159 43.0 572 38.3
Yes 210 56.0 262 69.9 237 63.7 211 57.0 920 61.7
Religion
Catholic 64 17.1 48 12.8 46 12.4 51 13.8 209 14.0
Seventh Day Adventist/Baptist 26 7.0 68 18.1 157 42.2 36 9.7 287 19.2
Other Christian 275 73.5 242 64.5 168 45.2 280 75.7 965 64.7
Muslim 7 1.9 9 2.4 1 .3 1 .3 18 1.2
None 2 .5 0 .0 0 .0 0 .0 2 .1
Other 0 .0 8 2.1 0 .0 2 .5 10 .7
Ethnicity
Chewa 16 4.3 5 1.3 5 1.3 7 1.9 33 2.2
Lomwe 327 87.4 285 76.0 275 73.9 350 94.6 1,237 83.0
Mang’anja 3 .8 51 13.6 59 15.9 3 .8 116 7.8
Ngoni 2 .5 9 2.4 7 1.9 1 .3 19 1.3
Nyanja 22 5.9 1 .3 2 .5 3 .8 28 1.9
Sena 1 .3 6 1.6 1 .3 1 .3 9 .6
Yao 3 .8 3 .8 0 .0 3 .8 9 .6
Khokhola 0 .0 15 4.0 23 6.2 2 .5 40 2.7
Marital status
Never married 8 2.1 12 3.2 5 1.3 3 .8 28 1.9
Currently married 271 72.3 233 62.1 242 65.1 270 73.0 1,016 68.1
Widowed 45 12.0 52 13.9 67 18.0 39 10.5 203 13.6
Divorced/separated 51 13.6 78 20.8 58 15.6 58 15.7 245 16.4
Relationship to reference girl
Parent/guardian 174 46.4 253 67.5 227 61.0 225 60.8 879 58.9
Grandparent 60 16.0 61 16.3 87 23.4 72 19.5 280 18.8
Sibling 61 16.3 24 6.4 24 6.5 38 10.3 147 9.9
Maternal uncle/uncle 36 9.6 21 5.6 17 4.6 22 5.9 96 6.4
Paternal aunt/uncle 11 2.9 6 1.6 6 1.6 8 2.2 31 2.1
Cousin 6 1.6 3 .8 5 1.3 0 .0 14 .9
Other 27 7.2 7 1.9 6 1.6 5 1.4 45 3.0

Finally, given that more than four in five respondents (84.9%) Discussion
reported that child marriage may happen because of pregnancy in
their community, we investigated the possibility that child mar- Our results indicate that child marriage may not be a social
riage occurs because of social norms and sanctions related to norm in these communities in Southern Malawi. Other studies
adolescent sexuality and access to contraception. Although we did indicating strong child marriage norms have shown high levels
not have measures of social expectations related to these topics in of both empirical and normative expectations [20], with partic-
our baseline dataset, we did measure adult decision-makers’ at- ipants reporting that there are sanctions when the norm is not
titudes toward adolescent sexuality and girls’ access to sexual and complied with [6]. In addition, social norms theory suggests that
reproductive health services, as shown in Table 4. More than 9 of as social norms relax or shift, empirical expectations should
10 (92.7%) adult decision-makers agreed with the statement decrease before normative expectations [21]. Instead, the ma-
“Unmarried girls who get pregnant are naughty,” and fewer than 1 jority of our sample had high empirical expectations, weak
in 20 felt it was acceptable for boys (4.1%) or girls (3.8%) to have sex normative expectations, and little concern for sanctions, indi-
before marriage. In addition, less than half (44.5%) agreed with the cating that child marriage is likely a descriptive norm, defined as
statement “All girls have a right to access contraceptives/family one that people follow because they think others are doing it or
planning services,” and even fewer (37.9%) agreed that unmarried because they lack alternative options [4,16]. As explained further
adolescent girls should have access. Fully four of five adult below, we specifically hypothesize that child marriage occurs
decision-makers (79.7%) felt that “Giving unmarried girls access because of a lack of alternative options for adolescent girls.
to contraceptives makes them promiscuous.” Therefore, although norms may provide a partial explanation for
S42 M. Steinhaus et al. / Journal of Adolescent Health 64 (2019) S37eS44

Table 3
Percent agreement with statements related to prudential reasons, personal normative beliefs, and social expectations regarding child marriage at baseline by site,
Malawi, 2017

Chiwalo Mchiramwera Changata Nazombe Total

(n ¼ 375) (n ¼ 375) (n ¼ 372) (n ¼ 370) (n ¼ 1,492)

% CI % CI % CI % CI % CI

Empirical expectations
Most girls in this community marry before the age of 18 y 85.1 79.3, 89.4 94.1 89.6, 96.7 95.1 89.7, 97.8 82.7 76.9, 87.3 89.3 86.9, 91.3
Normative expectations
Most people in this community expect girls to marry before 53.6 45.0, 61.9 48.5 43.5, 53.6 62.6 55.9, 68.9 48.1 42.7, 53.5 53.2 49.9, 56.4
the age of 18
Sanctions
If I do not ensure my daughters and/or nieces are married 54.0 45.8, 61.9 31.1 26.4, 36.2 36.8 31.8, 42.0 23.9 18.4, 30.4 36.4 33.4, 39.6
early, my family will not be respected in the community
Personal normative beliefs
It is wrong to marry a girl before the age of 18 91.6 87.7, 94.4 93.9 90.9, 95.9 88.9 83.9, 92.6 94.6 91.9, 96.4 92.3 90.5, 93.7
Prudential reasons
Marrying girls at a young age can help provide them security 9.6 6.5, 13.9 7.2 5.1, 10.1 7.8 5.4, 11.1 7.3 5.3, 9.9 8.0 6.7, 9.5
Marrying girls young can help prevent sexual violence, 14.4 10.0, 20.3 6.1 4.0, 9.3 10.5 8.0, 13.6 9.2 6.7, 12.5 10.1 8.4, 11.9
assault, and harassment
Marriage of girls under 18 y sometimes happens for 62.4 57.6, 67.0 64.5 59.7, 69.1 58.9 51.8, 65.6 57.0 51.0, 62.9 60.7 57.9, 63.5
financial reasons
Marriage of girls under 18 y mostly happens because there 81.1 78.0, 83.8 74.4 69.5, 78.8 80.4 76.0, 84.1 76.8 69.2, 82.9 78.2 75.6, 80.5
is a lack of education and job opportunities
Marriage of girls under 18 y may happen because of 79.2 71.4, 85.3 90.1 86.4, 92.9 83.9 76.9, 89.0 86.5 81.0, 90.5 84.9 82.0, 87.4
pregnancy in this community

child marriage in these communities, they are likely not the questions, which were individual items within Plan’s Child
exclusive or primary reason for child marriage. Marriage Acceptability score module and included words such
Fortunately, we could explore several complementary as “may” or “sometimes,” possibly overestimating agreement
explanations for child marriage within the baseline data. Par- among respondents to our survey.
ticipants reported prudential reasonsdespecially financial Additionally, social norms related to adolescent sexuality and
reasonsdfor girls marrying before the age of 18 years in these pregnancy might indirectly drive girls toward marriage. In our
communities. This means that child marriage is likely, in part, sample, we found strong, negative attitudes toward adolescent
the result of financial constraints that eliminate alternatives to sexuality and use of and access to family planning methods and
marriage for girls who are unable to attend school or find services. Given that adult decision-makers are key gate-keepers
gainful employment. This is consistent with recent work by to adolescents’ access to sexual and reproductive health ser-
Mann et al. [22] in Zambia that found that “economic factors, vices, these findings suggest that adults in these communities
including household poverty, are more likely to drive child hold strong moral opinions that may prevent adolescent girls
marriage than cultural pressures” and that “sex and marriage from accessing the services they need to avoid pregnancy. Other
were often pursued in the absence of any other available ave- studies have shown that these attitudes, if present in a com-
nues”. However, our data on prudential reasons should be munity with strong social sanctions against having children
interpreted cautiously, as we were limited by the wording of the outside of marriage, may first expose adolescent girls to a high

Table 4
Baseline attitudes toward adolescent sexuality and girls’ access to sexual and reproductive health services by site, Malawi, 2017

Chiwalo Mchiramwera Changata Nazombe Total

(n ¼ 375) (n ¼ 375) (n ¼ 372) (n ¼ 370) (n ¼ 1,492)

% CI % CI % CI % CI % CI

Agree that.
It is acceptable for girls to have sex before marriage 4.0 2.3, 6.9 1.1 .4, 2.6 7.0 4.8, 10.2 3.0 1.8, 4.9 3.8 2.9, 4.9
It is acceptable for boys to have sex before marriage 4.8 2.9, 7.8 1.6 .8, 3.1 7.3 5.0, 10.5 2.7 1.7, 4.3 4.1 3.2, 5.2
Unmarried girls who get pregnant are naughty 95.4 92.9, 97.1 90.7 88.6, 92.4 91.7 88.9, 93.8 93.2 90.3, 95.3 92.7 91.5, 93.8
Agree that.
All girls have a right to access contraceptives/family 43.4 36.3, 50.8 38.9 33.2, 44.9 47.2 41.8, 52.6 48.8 41.7, 55.8 44.5 41.3, 47.8
planning services
Unmarried adolescent girls should have access 39.3 32.8, 46.2 32.5 27.9, 37.5 44.6 38.3, 51.2 35.1 29.2, 41.6 37.9 34.9, 41.0
to contraception/family planning services
Married adolescent girls should have access 96.0 92.7, 97.8 94.7 91.8, 96.6 91.4 84.3, 95.4 96.4 92.3, 98.4 94.6 92.6, 96.1
to contraception/family planning services
Giving unmarried girls access to contraceptives 84.6 80.1, 88.3 76.7 72.4, 80.6 74.7 70.0, 78.8 82.8 78.9, 86.0 79.7 77.6, 81.6
makes them promiscuous
I would like contraceptives/family planning services 39.2 33.7, 44.9 37.5 33.3, 41.9 41.2 35.1, 47.6 40.5 34.6, 46.7 39.6 36.8, 42.4
to be available to girls in my community

CI ¼ confidence interval.
 M. Steinhaus et al. / Journal of Adolescent Health 64 (2019) S37eS44 S43

risk of becoming pregnant and then lead to the social expectation explicitly designed to change norms; ICRW’s inclusion of social
that they marry [11,13]. norms measures is exploratory.
Finally, limitations in our measures may have prevented us Notwithstanding these limitations, our data suggest that child
from revealing the underlying norms around child marriage in marriage is less a social norm in these communities, but more the
these communities. Few studies to date have validated these result of poverty and negative attitudes toward and norms
questions; it could be that decision-makers did not understand around adolescent sexuality and contraceptive access that result
the question or had a different interpretation of what the ques- in adolescent pregnancy. We suggest that future research on
tions were asking than was intended. To mitigate this risk, these child marriage in Southern Malawi investigate adolescent preg-
questions and their translations were reviewed with the nancy, norms around adolescent sexuality, and attitudes around
enumerators during training and included in the survey pilot adolescent access to and use of contraception. Our experience
before data collection. It also could be that the measure of implementing these norms measures also suggests that
sanctions, although determined with the implementing partners, researchers interested in investigating norms on child marriage
did not match with the sanctions most often experienced in the must not only take into consideration social expectations about
community. Social desirability bias, and the recent push to child marriage but must continue to acknowledge how other
enforce laws against child marriage, may have prevented re- factors such as prudential reasons, knowledge of laws, attitudes,
spondents from responding honestly. Finally, it should be noted and related norms such as those related to adolescent sexuality
that our article was motivated by a desire to understand norms are at play.
around child marriage and not the myriad of other important Similarly, data about all drivers of child marriage,
norms, such as those related to girls’ education and sexuality, including norms, economic insecurity, access to schools, and
that shape child marriage itself. attitudes toward adolescent sexuality, need to be considered
Our results offer many lessons learned that may improve the when developing evidence-informed programming. For im-
quality of social norms research related to child marriage. First, it plementers, program activities that target key decision-
is essential to conduct formative research to challenge any makers for adolescent girls, such as parents, to reduce
preconceptions about norms related to child marriage or key negative opinions of contraceptive use among youth may
reference groups. In addition, quantitative data collection should better link to changes in behavior. It is also important that
always be paired with qualitative data collection to increase future work explore and potentially build upon existing
explanatory power. Furthermore, even studies with advanced prosocial or protective norms.
norms measures should include questions about prudential
reasons for marriage and alternative norms that may indirectly
Acknowledgments
perpetuate child marriage to be able to support or exclude them
as additional contributing factors. Finally, given our measure of
The authors would like to thank Denise Dunning, Chantal
normative expectations and our measure of sanctions did not
Hildebrand, Josie Ramos, and Emily Teitsworth of PHI/Rise Up;
have similar levels of agreement, we recommend avoiding using
Faith Phiri, Grace Kanjo, and Tamara Mhango of Girls
them interchangeably.
Empowerment Network of Malawi and Amy Pennington at the
Despite the information we were able to glean from this
Gates Foundation for their review of the protocol materials.
survey about measurement of norms related to child marriage
International Center for Research on Women thanks Leigh
and the potential drivers of child marriage in these commu-
Stefanik of CARE for her contributions to our social norms
nities in Southern Malawi, our study had several limitations.
measures and Paul Nkhoma and the Millennium Consulting
First, we a priori chose to measure social norms in support of
Group for their dedicated contribution to study
child marriage and did not include measures that could have
implementation.
checked for normative expectations against child marriage. This
The team would also like to acknowledge the passion and
approach was selected based on the information gathered by
commitment of Rise Up’s Joyce Mkandawire, who was an
the implementing team during the intervention design phase,
invaluable member of ENGAGE. May she rest in peace.
which concluded that norms in these communities were sup-
portive of child marriage, hence the need for the intervention.
Second, although we plan to rigorously investigate norms Funding Sources
through qualitative vignettes and in-depth interviews in our
mid and end-line work, we were unable to do so at baseline, This work was supported by the Bill and Melinda Gates
limiting our ability to explore causality, sensitivity, and excep- Foundation research grant (OPP1148515) to the Public Health
tions to sanctions. Third, we conducted interviews with adults Institute, subawarded to the International Center for Research on
rather than girls, which means that we did not capture girls’ Women.
own perceptions of social expectations related to marriage.
Fourth, very few respondents chose a married reference girl for
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