The United Nations Population Fund and United Nations International Children’s Emergency Fund (UNPFA-UNICEF) Global Program to End Child Marriage cites ending child marriage as one of their 2030 sustainable development goals. Globally, advances have been made in decreasing the rate of child marriage. An estimated 650 million girls and women worldwide, 19% of women age 20 to 24 years who are currently alive, were married before the age of 18, a decrease from 22% a decade ago. Yet it continues to be a problem that disproportionately affects girls worldwide. From the years of 2015 to 2024 child marriage affected 47.6 million girls compared to 5.8 million boys. South Asia, particularly India, as well as sub-Saharan Africa see the highest rates of child brides and to a lesser degree, Latin America and the Caribbean.
The United States has a notable history of child marriage. Between 2000 and 2018, nearly 300,000 children, mostly girls and some as young 10 years old, were married in the United States. Nevada, Idaho, Arkansas, Kentucky, and Oklahoma had the highest rates of child marriage. There are no federal laws restricting child marriage in the United States, but rather legislation is dictated at the state level. As of 2025, only 16 states and two territories have banned child marriage for anyone under the age of 18 years without exception. Meanwhile, state-to-state minimum age can range from 15 to 18 years of age but with loopholes and exceptions based on parental consent with or without judicial permission, emancipation, and/or exceptions can be made in the case of pregnancy. Two states—Hawaii and Kansas—have set the age floor at 15 years, and four states and two territories have no minimum age requirement at all. Conversely, in many states that allow child marriage, a divorce cannot be obtained until the individual is of legal age.
Further complicating the landscape of child marriage is the concept of statutory rape. Depending on factors such as age difference, sex with a child is a misdemeanor or felony; the exception is in the instance of child marriage. Research in 2022 estimated that of all child marriages in the United States from 2000 to 2022, statutory rape laws were violated in as many as 14 states.
Several reasons have been given as to why there are no bans on child marriage in certain states. Outside of pregnancy as a reason for marriage, many cite religious mandates or cultural norms as reasons why child marriage has not been banned, even in the United States. And yet, there are no major religious traditions that require child marriage.
Child marriage has a significant negative impact on the health of girls. Those who marry prior to age 18 are at an increased risk of sexual and intimate partner violence. Several factors may contribute to this increased risk such as an inherent lack of autonomy and power imbalance. Wide spousal age and education gaps may further contribute to the inequality within the relationship.
The American College of Obstetricians and Gynecologists (ACOG) define intimate partner violence (IPV) as “a pattern of assaultive behavior and coercive behavior that may include physical injury, psychologic abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and reproductive coercion.” ACOG cites the U.S. Department of Health and Human Services and Institute of Medicine’s recommendation that IPV screening and counseling be a fundamental part of all women’s health visits.
The American Academy of Family Physicians cite several screening instruments that can be used to identify IPV, among them are HARK, which can assess for emotional and physical IPV within the past year; HITS, which assesses the frequency of abuse, or the extended version E-HITS, which also includes sexual violence; PVS, which assesses physical abuse and safety; and WAST, which assesses physical and emotional IPV. Additionally, legislation against child marriage as well as advocacy can positively impact rates of IPV. Multinational research has shown that protective child marriage laws and advocacy were not only associated with reduced rates of girls experiencing physical and sexual abuse but also improved attitudes against violence against women.
Research related to child brides in the United States or other high-income countries is limited, but we know that child marriage can impact girls through the detrimental effects of increased rates of maternal and infant morbidity and mortality, increased rates of mental health conditions, and increased rates of IPV associated with adolescent pregnancy. Child marriage inherently increases the risk of adolescent pregnancy typically through limited autonomy and limited access to contraception. Globally, adolescent pregnancy is associated with higher rates of eclampsia, peripartum endometritis, systemic infections, preterm birth, and infants with low birth weight and severe neonatal conditions.
Pregnant adolescents also are at increased risk for depression, postpartum depression, suicidal ideation, low self-esteem, substance use, anxiety, and IPV. Some estimates put the rate of postpartum depression as high as 40% of all adolescent mothers. Additionally, postpartum depression in adolescents has been found to persist longer after delivery than adult mothers and increases the likelihood of shorter duration to subsequent pregnancy.
The National Health Resource Center on Domestic Violence recommends clinicians screen for IPV every trimester as well as postpartum, which is consistent with the recommendations of other national organizations that screening be included in every facet of women’s healthcare. Routine screening and heightened vigilance by the clinician are necessary to enable improved outcomes in this vulnerable population.
Global research focused on the mental health outcomes of child brides is also limited. However, what is available has identified increased rates of depression, anxiety, and post-traumatic stress disorder. Suicidal ideation and suicide attempts were found to be twice as likely in child brides. Child marriage also has been shown to increase rates of substance use and abuse. However, confounding factors, such as the impact of poverty on the mental health of child brides, may impact current research. Regardless of circumstances, all adolescents should be screened for mental health conditions during preventive visits.
Globally, child marriage remains an ongoing problem, an end of which is not expected to be achieved by the UNFPA-UNICEF sustainable development goals in 2030. Currently, the United States has yet to contribute to the end of this practice through legislation at the state or federal level. Until this happens girls who are involved in child marriage will continue to face increased rates of IPV and psychological and physical health consequences. In addition to providing adequate and timely screening, clinicians also can serve as advocates for these patients.
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