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Over the last 20 years, adolescent health researchers, practitioners and advocates have zeroed-in on the global problem of ‘child marriage.’ Defined as a formal or informal marital union before 18 years, child marriage affects both boys and girls, but disproportionally affects girls. Globally, child marriage is noticeably prevalent but on a downward trend, with the proportion of 20-24 year old women marrying before 18 years decreasing from 25% to 19%, from 2008 to 2020 (UNICEF, 2018; 2022). Extensive research has shown the adverse consequences of marrying during adolescence, ranging from increased risk of maternal mortality and birth complications, intimate partner violence (IPV), adverse mental health and intergenerational poverty outcomes (Burgess et al., 2022; Clark, 2004; Nour, 2009; Otoo-Oyortey & Pobi, 2003; UNICEF, 2018). From a rights perspective, child marriage is considered a violation of girls’ and boys’ ‘right’ to fully consent into marriage before reaching age of majority, internationally recognized as 18 years of age (Bruce, 2003; Nour, 2009). As such, child marriage is recognized as a human rights violation under several international treaties, including the Convention on the Rights of the Child (CRC). The term ‘child marriage’ is commonly used to convey the human rights violations that early marital practices have for under-age girls and boys. While the term ‘child marriage’ has mobilized consensus and solidarity toward the issue, this terminology also homogenizes the issue of marriage as a problem affecting the ‘girl child’ with little to no agency in the marriage decision-making process. More specific to Uganda, this ‘child marriage’ terminology can be problematic where marriage more commonly occurs during middle to late adolescence (15-19 years) and when adolescents may exert varying degrees of agency and consent in the marital decision-making process. Except for Chapter 1 which explores ‘child marriage’ global and national movements, I intentionally use the terminology ‘adolescent marriage’ (as marriage before age 18), rather than ‘child marriage,’ throughout this dissertation. Despite the global push to ‘end child marriage’ over the last decade, there is limited research about how broader social and structural factors may be driving declines in adolescent marriage (Muthengi et al., 2021; Plesons et al., 2021). In particular, we have a limited understanding about how global efforts, social processes and norms might work together to drive marriage declines among adolescents. Through a mix of policy, quantitative and qualitative methods, this dissertation examines the policy, structural and social mechanisms that have contributed to declining adolescent marriage among adolescent girls in the context of southcentral Uganda. Chapter 1 begins with a broader contextual lens, examining the political evolution of the global ‘child marriage’ movement, and how the ‘problem’ of child marriage was then taken-up by government and civil society actors in Uganda. This chapter is informed by 20 key informant interviews with Ugandan and global stakeholders working on child marriage and a desk review of over 130 documents gathered across four years. This chapter highlights how the global ‘child marriage’ movement marked a political shift in adolescent girl funding, repackaging the issue of early marriage as an issue of ‘child protection.' The focus on child protection, rather than adolescent sexuality, was instrumental in mobilizing attention from liberal and conservative funders in the Global North and policy-makers in the Global South. In the priority country of Uganda, multiple factors influenced the national policy uptake of child marriage, including: 1. Regional campaigns that created consensus among Eastern and Southern African country leadership to address child marriage; 2. The availability of national data that showed the reach and severity of child marriage within Uganda; 3. The cultural and political appeal of child marriage as an issue of ‘child rights’, rather than one of ‘sexuality,’ and; 4. A network of government leaders, academics, international non-governmental organizations (INGOs) and civil society organizations (CSOs) who coalesced behind the issue in Uganda. Chapter 2 focuses-in on the southcentral region of Uganda, leveraging close to 20 years of quantitative data to understand how social and structural factors are affecting adolescent marriage declines in the region. Using data from 13 surveys (1999-2018) of the Rakai Community Cohort Study (RCCS), I couple decomposition and causal inference methods to assess how social determinants and adolescent pregnancies have contributed to adolescent marriage declines among 15 to 17 year old girls. I find that both marriages and pregnancies among adolescent girls substantially declined over the last 20 years, from 24% to 6%, and 28% to 8%, respectively, between 1999 and 2018, as a result of educational and economic improvements. Among all social determinants, girls’ secondary schooling was more closely associated with lower risk of marriage and pregnancy (aOR marriage = 0.09; 95%CI=0.07, 0.12; aOR pregnancy = 0.14; 95% CI=0.11; 0.19). In the causal mediation analyses, lower pregnancy rates partially explained the positive effect of higher secondary schooling on lower risk of adolescent marriage. Decomposition analyses showed that the declines in adolescent marriage between 1999 to 2018 were primarily attributed to pregnancy declines, and to a lesser extent, improvements in education and SES. These findings reemphasize the sizeable role of education in preventing adolescent marriages, in line with Uganda’s national educational investments such as universal primary education (UPE). Yet, these findings also underline the importance of adolescent pregnancy prevention to delay age at marriage. In the same region of southcentral Uganda, Chapter 3 uses secondary ethnographic data to more deeply explore the social mechanisms and norms that have contributed to changes in adolescent marriages. I qualitatively explore how the region’s social and economic changes have affected social norms about adolescent sex, courtship, and marriage in Rakai, Uganda. This analysis is informed by 16 focus group discussions and 15 key informant interviews conducted in 2018 with younger and older women and men, ranging from 16 to 77 years old. In comparing generational perspectives, I identify a ‘normative transition’, in which new structures are transforming courtship and marriage processes for young people. First, the HIV epidemic significantly weakened family structures, and in the process, courtship and marriage guidance previously provided by families and elders; second, the loss of land ownership in between generations has made marriage preparations more difficult for young people; and third, new social spaces outside the family home – including discos, mobile phones and schools - have expanded young people’s romantic geographies prior to marriage. These changes have reduced the importance of the family institution in the marital decision-making process, while increasing young women’s and men’s autonomy in engaging in premarital sex, choosing their partners, and delaying marriage. Although these changes have delayed age at marriage beyond adolescence, this transition has introduced unanticipated challenges for young people as they enter adulthood, including lack of overall parental, familial and elder guidance in their relationship and marriage formation processes. Taken together, these findings highlight the complexity of adolescent marriage changes and prevention efforts at the global, Ugandan, and southcentral region of Uganda. First, global and national ‘child marriage’ movements played a significant role in the uptake of child marriage as an issue of ‘child protection’, rather than one about ‘sexuality’ in Uganda. Yet looking at the context of southcentral Uganda, adolescent pregnancies and adolescent marriages declines appear to be closely linked, highlighting the importance of conceptualizing adolescent marriage as not just a child protection issue, but one of adolescent sex and sexuality. Lastly, I find that broader structural and social changes in Rakai have substantially changed adolescent norms around sex, courtship, and marriage, delaying age at marriage in between generations. However, young people are encountering new challenges as they enter adulthood and romantic relationships in the absence of pre-existing elder and familial systems and networks. Additional research should focus on understanding the unintended consequences of catalyzing norm change and delaying age at marriage, including how these changes might affect familial and community relationships and kinships. Twenty years into the global push to end ‘child marriage’, this dissertation research provides new insights into the complex structural, social and sexuality drivers of adolescent marriage changes in Uganda. Despite the substantial progress in adolescent marriage declines, this research points to key gaps that will need to be addressed to improve adolescent SRH rights and needs in Uganda, the East African region, and beyond. Of particular importance is the need to center adolescent sexuality within current child marriage efforts, as well as focusing on the broader social changes affecting adolescent relationship formation, rather than exclusively focusing on age at marriage as a marker of social change.

Childhood trauma experiences (sexual abuse, physical abuse, witnessed violence, and early separation experiences) and family environment characteristics were assessed via questionnaire from a sample of depressed borderline (N=17) and depressed nonborderline (N=19) female inpatients. Significantly more borderline individuals than nonborderlines gave histories of sexual abuse (76%) and physical abuse (93%) and these traumatic experiences were more severe in nature as demonstrated by significantly greater composite scores. While the presence of witnessed violence did not differentiate the two groups, borderline individuals witnessed violence more frequently than nonborderline individuals if there was violence in the home. Early separation experiences were relatively common in both groups suggesting that these experiences may be associated with both BPD and depression. The BPD group was also distinctive on family environment measures, evidencing significantly less family cohesiveness and expressiveness and significantly more conflict and control. The two groups were similar on indices of current stressors, typically associated with onset of depression, providing more support for the role of childhood trauma in the etiology of BPD. / Master of Science

[pt] A presente dissertação resulta de uma pesquisa realizada junto aos conselheiros tutelares da cidade de Manaus com o objetivo de conhecer a atuação dos mesmos na defesa e proteção dos direitos de crianças e adolescentes vítimas de violência doméstica. O estudo, de natureza qualitativa, utilizou a entrevista semi-estruturada que foi realizada individualmente junto a 12 conselheiros oriundos de todos os Conselhos Tutelares da cidade (áreas urbana e rural). As entrevistas foram gravadas com a permissão dos entrevistados e após sua transcrição os dados foram organizados em dois grupos. O primeiro com informações acerca do perfil dos conselheiros entrevistados, suas motivações, capacitações na área dos direitos da criança e do adolescente e da violência doméstica, bem como das vantagens e desvantagens do trabalho que realizam. O segundo, organizado em torno de três eixos temáticos: concepções de violência doméstica, procedimentos e dificuldades encontradas diante de sua ocorrência, e avaliação do trabalho realizado frente às situações de violência doméstica. O tratamento dos dados foi realizado com base na análise de conteúdo proposta por Bardin. Os achados permitiram observar que a principal motivação dos entrevistados para trabalhar como conselheiros foi o interesse em ajudar a população infantil, que a capacitação que os mesmos receberam na área dos direitos de crianças e adolescentes, bem como sobre violência doméstica foi apenas introdutória, que a autonomia do cargo é vista como principal vantagem e que conciliar as horas dedicadas ao trabalho e à vida pessoal é a maior desvantagem. Os entrevistados concebem a violência doméstica em moldes que não se distanciam do apresentado pela literatura e acreditam ser a mesma um fenômeno de difícil intervenção. Contudo, suas ações se assemelham a controle de conduta, reclamam do excesso de demanda e da falta de eficiência da rede de proteção e manifestam sentimento de impotência no alcance de suas atribuições. Com base nestes achados, sugere-se maior atenção à capacitação dos conselheiros e a contratação de uma equipe técnica para avaliar os casos e subsidiar as decisões do Conselho Tutelar. / [en] The current dissertation is the result of a research done together with the tutelary counselors of the city of Manaus with the objective of knowing how they act in the defense and assurance of the rights of children and adolescents victims of domestic violence. In order to do so, a qualitative study was undertaken and the main instrument for data colection was a semi-structured interview which was carried out with 12 tutelary counselors, each one from a different Tutelar Counselor in the city (urban and rural areas). The interviews were recorded with the permission of the counselors and after their transcription the responses were organized in two groups. The first one gathered information about the counselors characteristics, their motivations, preparation for acting in the area of children and adolescent’s rights and domestic violence, as well as the advantages e disadvantages that permeate their activities. The second one was organized around tree thematic axes: conceptions about domestic violence, procedures and difficulties in face of its ocurrence, and their evaluation of the work developed in the area of domestic violence. Data were analysed by the Bardin content analysis. Our findings indicate that for the counselors interviewed in this study the main motivation for their work as counselors is their interest in helping that segment of our population and that the capacitation they received regarding children and adolescents’ rigths as well as domestic violence was only introductory. Our results also indicate that the autonomy of their job is seen as the main advantage for them and that the difficulty in managing the hours dedicated to work and personal life is seen as the main disadvantage. They also conceive domestic violence as presented by the literature and they believe that it is a phenomenum of difficult intervention. Nevertheless, their actions regarding this phenomenum resemble conduct control. The tutelary counselors complain about an excess of demand and a lack of efficaciousness of the protection network. Also they express a feeling of impotence with regards to the accomplishment of their duties. All considered, a better attention towards the qualification of the counselors and the recruitment of a technical team to evaluate cases and subsidize the decisions of the Tutelar Counselor is suggested.

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Text in Afrikaans / Hierdie studie het ten doel gehad om die effek van gesinsgeweld op die Suid-Afrikaanse kind te bepaal. Die Opvoedkundig-Sielkundige Relasieteorie is gebruik in die identifisering van die effek van gesinsgeweld op die kind. Die volgende is in die studie bevind: Die geweldsvraelys kan gebruik word om die effek van gesinsgeweld by die kind te identifiseer en ook as hulpmiddel dien vir die terapeut in die verband. Die Opvoedkundig-Sielkundige Relasieteorie kan gebruik word om die effek van gesinsgeweld by die kind te identifiseer. Kinders wat geaffekteer word deur gesinsgeweld toon sterker deursettingsvermoe en wilskrag ten einde 'n sukses te maak van hulle toekoms en om nie in dieselfde omstandighede te beland nie. Seuns en dogters se emosionele ervarings toon weinig verskille. Relasie met ouers in gesinsverband word negatief be"invloed, terwyl relasie buite gesinsverband positief voorkom. Kinders wat geaffekteer word deur gesinsgeweld kan gehelp word, al is dit om die kind te verwyder uit die omgewing asook met terapie, gesinsterapie, ensovoorts. / The study was conducted to determine the effect of family violence on South-African children. The Education-Psychological Relation theory was used to identify these effects. In the literature, the following was concentrated on: The questionnaire can determine the effects of family violence on a child and assist a psychologist in this regard. Education-Psychological Relation theory can determine the effects of family violence on a child. Children affected by family violence show a stronger determination and willpower to succeed in their future and not to stay in similar situations. The emotional experiences of boys and girls show little difference. Relationships with parents are negatively affected, but relationships outside the family circle tend to be positive, Finally, children affected by family violence can be helped, albeit to remove the child from the enviroment and to use psychological therapy, family therapy, ectera. / Educational Studies / M. Ed. (Guidance and Counselling)

Text in Afrikaans / Hierdie studie het ten doel gehad om die effek van gesinsgeweld op die Suid-Afrikaanse kind te bepaal. Die Opvoedkundig-Sielkundige Relasieteorie is gebruik in die identifisering van die effek van gesinsgeweld op die kind. Die volgende is in die studie bevind: Die geweldsvraelys kan gebruik word om die effek van gesinsgeweld by die kind te identifiseer en ook as hulpmiddel dien vir die terapeut in die verband. Die Opvoedkundig-Sielkundige Relasieteorie kan gebruik word om die effek van gesinsgeweld by die kind te identifiseer. Kinders wat geaffekteer word deur gesinsgeweld toon sterker deursettingsvermoe en wilskrag ten einde 'n sukses te maak van hulle toekoms en om nie in dieselfde omstandighede te beland nie. Seuns en dogters se emosionele ervarings toon weinig verskille. Relasie met ouers in gesinsverband word negatief be"invloed, terwyl relasie buite gesinsverband positief voorkom. Kinders wat geaffekteer word deur gesinsgeweld kan gehelp word, al is dit om die kind te verwyder uit die omgewing asook met terapie, gesinsterapie, ensovoorts. / The study was conducted to determine the effect of family violence on South-African children. The Education-Psychological Relation theory was used to identify these effects. In the literature, the following was concentrated on: The questionnaire can determine the effects of family violence on a child and assist a psychologist in this regard. Education-Psychological Relation theory can determine the effects of family violence on a child. Children affected by family violence show a stronger determination and willpower to succeed in their future and not to stay in similar situations. The emotional experiences of boys and girls show little difference. Relationships with parents are negatively affected, but relationships outside the family circle tend to be positive, Finally, children affected by family violence can be helped, albeit to remove the child from the enviroment and to use psychological therapy, family therapy, ectera. / Educational Studies / M. Ed. (Guidance and Counselling)

The purpose was to give a theoretical perspective on domestic violence in middle-childhood. The aim was therefor to explore and describe domestic violence in middle-childhood from a Gestalt perspective with guidelines for play therapists to utilise with middle-childhood children experiencing domestic violence. Due to the nature of qualitative research triangulation was used where firstly an in-depth literature study on middle-childhood, the Gestalt approach and domestic violence. Secondly semi-structured interviews in the empirical research in example a self-developed questionnaire. Together with this mediums and techniques of Gestalt play therapy for the main purpose of obtaining more information from the respondents. The literature was utilised from a explorative and descriptive nature of the research to refine concepts through semi-structured interviews with six children as respondents. This information is given graphically and applied for guidelines from Gestalt perspective to play therapists to assist these children. The objectives of the study have thus being achieved. / Practical Theology / M. Diac.

The effects of having witnessed their fathers’ violent behaviour impacts on daughters for a long period afterwards, even in adulthood. This study explores this phenomenon by means of literature review and interviews. The literature indicates that the effects of paternal violence is linked to forced maturity, secrecy, pretending, self-blame, and negative impact on the daughter’s relationships with both parents. A narrative approach was used to interview three adult participants. The conversations were analysed using thematic analysis and hermeneutics. Themes that emerged include avoidance, ambivalence towards the parents, aggression, assertiveness, and over-responsibility. There is a tendency to avoid intense, emotionally-laden, ambiguous and unpredictable situations through the use of interpersonal vigilance, an emotionally strong poise, distancing, being agreeable and devoutness. Also, there is a fear of becoming just like their abusive father. The psychological impact of being witness to a father’s violent behaviours has long-lasting effects on daughters. / Psychology / M.A. (Clinical Psychology)

Women and young people who have experienced domestic violence view themselves through an abuse-dominated lens, causing thin descriptions of themselves. Research was undertaken with seven women and eleven young people to explore how they had experienced domestic violence and to co-author and co-construct new stories of identity. This research addressed how a narrative pastoral approach guides therapeutic conversations with people who have experienced domestic violence. A narrative approach has at its heart the notion of decentred practice and an ethic of care. Reflective letters after each group meeting played a central part of the research. The letters were structured to tell the alternative stories emerging during and between sessions. These stories were told and retold and in each telling the women artd young people experienced alternative views of self and joined others in this re-writing. Participants spontaneously continued to meet beyond the completion of the research / M. Th. (Practical Theology)