title: Cross-sectional time series analysis of associations between education and girl child marriage in Bangladesh, India, Nepal and Pakistan, 1991-2011.
abstract: BACKGROUND
  Girl education is believed to be the best means of reducing girl child marriage (marriage <18 years) globally. However, in South Asia, where the majority of girl child marriages occur, substantial improvements in girl education have not corresponded to equivalent reductions in child marriage. This study examines the levels of education associated with female age at marriage over the previous 20 years across four South Asian nations with high rates (>20%) of girl child marriage- Bangladesh, India, Nepal and Pakistan.
  
  
  METHODS
  Cross-sectional time series analyses were conducted on Demographic and Health Surveys (DHS) from 1991 to 2011 in the four focal nations. Analyses were restricted to ever-married women aged 20-24 years. Multinomial logistic regression models were used to assess the effect of highest level of education received (none, primary, secondary or higher) on age at marriage (<14, 14-15, 16-17, 18 and older).
  
  
  RESULTS
  In Bangladesh and Pakistan, primary education was not protective against girl child marriage; in Nepal, it was protective against marriage at <14 years (AOR = 0.42) but not for older adolescents. Secondary education was protective across minor age at marriage categories in Bangladesh (<14 years AOR = 0.10; 14-15 years AOR = .25; 16-17 years AOR = 0.64) and Nepal (<14 years AOR = 0.21; 14-15 years AOR = 0.25; 16-17 years AOR = 0.57), but protective against marriage of only younger adolescents in Pakistan (<14 years AOR = 0.19; 14-15 years AOR = 0.23). In India, primary and secondary education were respectively protective across all age at marriage categories (<14 years AOR = 0.34, AOR = 0.05; 14-15 years AOR = 0.52, AOR = 0.20; 16-17 years AOR = 0.71, AOR = 0.48).
  
  
  CONCLUSIONS
  Primary education is likely insufficient to reduce girl child marriage in South Asia, outside of India. Secondary education may be a better protective strategy against this practice for the region, but may be less effective for prevention of marriage among older relative to younger adolescents.
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, United States of America; Center on Gender Equity and Health, University of California San Diego, San Diego, CA, United States of America; Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education, Boston, MA, United States of America.
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, United States of America; Center on Gender Equity and Health, University of California San Diego, San Diego, CA, United States of America.
authors.forename: Lotus
authors.initials: L
authors.lastname: McDougal
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, United States of America; Center on Gender Equity and Health, University of California San Diego, San Diego, CA, United States of America.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
authors.affiliation: Vancouver Island Health Authority, Vancouver, Canada.
authors.forename: Melanie L A
authors.initials: ML
authors.lastname: Rusch
mesh_terms: D000293:Adolescent; D001459:Bangladesh; D003430:Cross-Sectional Studies; D004493:Education / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India; D008393:Marriage / Q000706:statistics & numerical data*; D009390:Nepal; D010154:Pakistan; D012306:Risk; D013997:Time Factors; D055815:Young Adult