title: Child marriage and its associations with controlling behaviors and spousal violence against adolescent and young women in Pakistan.
abstract: OBJECTIVE
  Child marriage (before 18 years) is widely prevalent in Pakistan, and disproportionately affects young girls in rural, low-income, and poorly educated households. Our study aims to determine the associations between child marriage and controlling behaviors (CB) and spousal violence by husbands against adolescent and young women in Pakistan beyond those attributed to social vulnerabilities.
  
  
  METHODS
  We analyzed data from the Pakistan Demographic and Health Survey, 2012-2013, of currently married women aged 15-24 years who had participated in the domestic violence module (n = 589, 22.5% [589/2,615] of the subsample aged 15-24 years) to identify differences in CB and spousal violence experiences between early (<18 years) and adult (≥18 years) ages at marriage. Associations between child marriage and CB and spousal violence by husband were assessed by calculating adjusted odds ratios (AOR) using logistic regression models after controlling for demographics, social equity indicators (education, wealth index, and rural residence), spousal age gap, and husband's education.
  
  
  RESULTS
  Overall, 47.8% of currently married women aged 15-24 years in Pakistan were married before the age of 18 years. About one third of women aged 15-24 years in Pakistan reported experiencing CB (31.8%) and spousal violence (31.1%) by their husbands. Compared with adult marriage, child marriage was significantly associated with CB (AOR = 1.50; 95% confidence interval [CI], 1.042-2.157), any form of spousal violence (physical or emotional) (AOR = 2.03; 95% CI, 1.392-2.969), emotional violence (AOR = 1.86; 95% CI, 1.254-2.767), and physical violence (AOR = 2.44; 95% CI, 1.582-3.760), including severe physical violence (AOR = 2.57; 95% CI, 1.122-5.872).
  
  
  CONCLUSIONS
  Effective interventions are needed to prevent child marriages and raise awareness about their negative consequences, with special reference to spousal violence.
authors.affiliation: Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany; Rollins School of Public Health, Emory University, Atlanta, Georgia; Injury Control Research Center, School of Public Health, West Virginia University, Morgantown, West Virginia. Electronic address: muazzam.nasrullah@gmail.com.
authors.forename: Muazzam
authors.initials: M
authors.lastname: Nasrullah
authors.affiliation: Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.
authors.forename: Rubeena
authors.initials: R
authors.lastname: Zakar
authors.affiliation: Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.
authors.forename: Muhammad Zakria
authors.initials: MZ
authors.lastname: Zakar
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008393:Marriage / Q000706:statistics & numerical data*; D010154:Pakistan; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000706:statistics & numerical data*; D014930:Women; D055815:Young Adult
keywords: Child marriage; Pakistan; Partner; Spouse; Violence; Women