A Social-Ecological Model to Explore Multi-Faceted Drivers of Child Marriage: An Iterative Qualitative Study in Southern Bangladesh.

Despite national priorities, legal reforms, and increased investment in interventions, child marriage (CM) remains a significant public health risk, leading to violence, intergenerational nutritional depletion, and poor health outcomes in Bangladesh. Using the social-ecological model (SEM), this iterative qualitative study aimed to understand the drivers of CM at the individual, familial, social/community, and institutional levels to inform policy and programs. A total of 29 focus group discussions (with community members, married and unmarried adolescent girls, and their parents and grandmothers), 44 in-depth interviews (with married and unmarried adolescent girls, and their parents), and 10 key informants' interviews (influential community leaders) were conducted. Findings were drawn through thematic analysis employing both inductive and deductive coding. Identified CM drivers are aligned with the SEM framework. Girls' agency, collective efficacy, self-initiated marriage, and educational performance were individual-level drivers. Family-associated drivers were household poverty, parents' lack of awareness, and intra-household gendered preferences. Social/community drivers include norms about the "ideal" bride, girls' readiness for marriage, control over girls' sexuality and mobility, fear of violence, family honor, and religious norms. Weak enforcement to prevent CM, limited opportunities for girls, ecological conditions, and long school closures during COVID-19 were key institutional drivers. Findings suggest CM drivers are interconnected across levels of the SEM, implying the need for multi-level interventions. Coordinated efforts to reduce CM may include addressing the harmful CM norms and systemic factors leading to CM, raising community awareness about the adverse outcomes of CM, and offering poverty alleviation and economic opportunities for girls.