Public Health Policy Practice for Early-Age Marriage in Gunung Kidul, Indonesia: An Evaluation of Regent Regulation Practice on Child Health

. Background: Early-age marriage becomes the raising issue regarding its implication, particularly on child health. The efforts to reduce this issue were by changing, monitor, and evaluate the rule of the limit age of marriage for children which was still inappropriately happened in Indonesia, especially in Gunungkidul. Purpose: This study evaluated the Regent Regulation practice as its both performance and effectiveness in improving child health in this region. Methodology: A qualitative design was used in this evaluation study with an in-depth interview and analyzed all governments' reports as secondary data collecting. Results: Regent Regulation of 36/2015 affected to reduce the case of child marriage in Gunungkidul. It reduced almost a half (45.78%) of the early-age marriage from 2015 to 2017. Informants confirmed that more than 1/3 divorce cases in this region were decreased as well as the suppressed dispensation for early-age marriage (<100 marriage) and lowest amount of maternity cases on the adolescent group. It was also effective in reducing the low-birth weight, from 2015 to 2017, and stunting cases on children, from 2015 to 2016. Conclusion: Positive externality of Regent Regulation of early-age marriage and its impacts was seen by affecting the spirit of the other regions to follow them.


Introduction
Child, Early, and Forced Marriage (CEFM) is a term that is internationally known to describe some similar conditions relating to underage marriage [1]. Child-age marriages are known to be a cause for various problems, especially for girls as a much-affected party. In terms of health in general, early marriage is associated with poor reproductive health status such as the high probability of severe anemia and severe Pregnancy Induced Hypertension (PIH) in pregnant women, premature births, unwanted pregnancies, pregnancy terminations (including miscarriage, stillbirth, and abortion), and low birth weight (LBW) [2][3][4].
Other things that need to be considered, health risks due to early marriage cause a cycle of intergenerational impacts that not only affects the mother but also the child she is born with. In addition to having a higher risk of death at birth, babies of child-aged brides are at a higher risk of dying before 1 year of age, as are LBW risks and malnutrition during their growth period [5,6] The intergenerational growth disorder cycle begins with the birth of LBW babies which will cause growth disruption in their children's period until they generally grow into less severe and short teens. The adolescent is less severe and short if married at an early age it is difficult to avoid early pregnancy which then will lead to the return of the cycle to the birth of babies with low birth weight status [7,8]. If these less heavy and short teens get married when they are adults, generally their nutritional status does not change much so that they grow up as less heavy and short adult women who will have the potential to give birth to LBW babies [9] The marriage age of children in Indonesia is still at 28.02% -so that placing Indonesia as the country with the second-highest rate of early marriage in ASEAN after Cambodia -requires attention 10 . The government has ratified the age limit for children at 18 years Law No. 1 of 1974 concerning Marriage which regulates the age limit of marriage. In its efforts to mature the age of marriage, the regulation regarding marriage was proposed for judicial review to the Constitutional Court (MK) because it was considered not in accordance with the times and needed adjustment. However, the failure to bring an effort to mature the marriage age in Law No. 1 of 1974 concerning Marriage to be granted by the Constitutional Court judges did not then dampen the steps of various parties who were concerned about the issue of child marriage. Gunungkidul Regency Special Province of Yogyakarta is one of the regions with a government that has the initiative to take a position on the issue of child marriage. Through the ratification of Gunungkidul Regent Regulation No. 36 of 2015 concerning Prevention of Marriage at the Age of Children, the local government shows its commitment to preventing early marriage. The evaluation of the marriage age limit policy in this study was conducted by photographing the phenomenon that occurred in Gunungkidul Regency, DI Yogyakarta Province through the establishment of a policy by the district government, namely Perbup Gunungkidul No 36/2015 concerning Marriage Prevention at the Age of Children.

Study design
This research was carried out by using a qualitative approach to explore and explore the attainment of marriage age regulation in preventing the practice of early marriage through a case study of Gunungkidul Regent Regulation No. 36 of 2015 concerning Prevention of Marriage at the Age of Children. In this study data taken through secondary data sources examined include:

Study setting
The study was conducted in Gunungkidul Regency, DI Yogyakarta to evaluate the achievement of marriage age limit settings through a case study of Gunungkidul Regent Regulation No. 36 of 2015 concerning Prevention of Marriage at the Age of Children in April-June 2018.

Ethics
The ethical feasibility of research on research and procedures carried out by researchers in the field is carried out as a condition before data collection is carried out in the field. The study was conducted after obtaining a recommendation from the Ethics Study

Results
Policy evaluation studies are carried out on this policy because it is considered appropriate because there has been a change in the decline in early marriage and marriage dispensation requests as well as community perspectives since the PPUA Regulation was enacted and implemented in 2015. Changes in underage marriage trends are shown in the data presented in subchapter on policy performance, while changes in the perspective of the community can be seen from the results of interviews with informants who stated that people began to think more difficult at this time if they want to marry off children at an age that is too young or underage. So that the study evaluation policy is suitable because of changes that seem almost comprehensive since the emergence of Perbup.
" Heu " euh, until now if there are good indicators, in Saptosari, the real indicators in the community are quite good. " Wah saiki nikahne boy iki angel " (now marrying this child is difficult). It was from the old preachers, such voices had appeared, this was a very good indicator, meaning they already had awareness even though at first it was rather "depressed". "-Wijang Eka Aswarna, Secretary of the Gunungkidul District Social Service.

Performance of Regent Regulation Practice
The performance of Gunungkidul Perbup policy No. 36 of 2015 concerning Marriage Prevention on the Age of Children can be seen through the achievement of several indicators. Indicators that show the progress of achieving this child-age marriage prevention effort can be seen from several things such as: a) The number of marriages of children age recorded at the Ministry of Religion, b) Dispensation requests submitted to the Religious Courts, and c) Birth of teenagers recorded by the Health Office.
The complexity of the phenomenon of child age marriage makes judging the performance of its policies cannot be seen through just one perspective. Data on underage marriages can show the incidence of child marriage that is legal and recorded in the KUA and reported to the Ministry of Religion Office, while the marriage dispensation request data shows the number of underage brides who intend to legalize their marriage so they must register a marriage dispensation request and be tried at Religious courts. In addition, some marriages may not be recorded due to the occurrence of extramarital pregnancies, so that detection can be done through the screening of labor data by mothers who are teenagers and recorded in data on adolescent delivery. The following are indicator data commonly used to assess the success of child age marriage prevention efforts obtained by researchers from the field and their descriptions:    5  1  0  6  1  0  0  1  2  1  0  3  3  5  0  8  3  0  0  0   14 Saptosari  3  7  5  15  7  4  2  13  7  3  2  12  4  0  0  4  1  0  0  1   15 Gedangsari  7  2  2  11  4  3  1  9  5  3  0  6  1  1  0  2  0  0  0  0   16 Girisubo  4  0  0  4  2  1  0  3  2  0  0  2  2  1  0  3  1  1  0  2   17 Tanjungsari  3  3  0  6  6  3  0  9  6  2  0  8  2  1  0  3  3  2  1  6   18 Purwosari  5  3  0  8  3  4  2  9  1  3  2  6  0  0  0  0  5  2  0  7 19 Data on underage marriage recorded both in the Ministry of Religion and in the Department of Population and Civil Registration of Gunungkidul Regency showed an increase in 2012 and 2013. In 2014 the figure has begun to decline presumably because of the emergence of efforts at the sub-district level as mentioned in history the formation of the Perbup in the previous sub-chapter. Pilot efforts in several sub-districts which are indeed enclaves of marital problems at the age of the child made the decline that occurred quite significant. Post-Perbup is formed so that it can be seen that the decline that occurs is increasingly showing a positive trend. The numbers even dropped so much that less than half the number of underage marriages in 2012.
In addition to this, there is a phenomenon that deserves further study in further research on marriage data based on gender. In the data, it appears that underage marriage is mostly done by men rather than women. Based on Law No. 1/1974 concerning Marriage, indeed the marriage dispensation applied to men is if male patients are less than 19 years old. Higher age requirements for men are believed to be due to the heavier responsibilities that must be carried out by men who will act as head of the family. More mature age is expected by men to be better prepared and better able to be responsible for their families. The obligation to provide for the family carried by men is one factor, with a more mature age men are expected to be more capable.
This is related to the number of reasons for divorce in 2016 which were recorded by the Gunungkidul Regency Dispendukcapil which occurred mostly due to economic problems. If a man does not have the ability to meet his family's financial needs, the resilience of a family will become weak and prone to divorce. Divorce cases in Gunungkidul Regency have experienced a downward trend from 2013 until the birth of the PPUA Regulation in 2015. Although it cannot be stated definitively that this is a contribution from the PPUA Regulation, this is seen as a positive thing by various parties. Based on the information from the Religious Court Judge interviewed by the researcher, it was found that there was a downward trend in the divorce case he handled which was a divorce because the couple was a couple who married underage. Data on recording divorce cases based on age was not obtained by researchers. Only data from Dispendukcapil found that in 2016 the divorce cases that occurred in Gunungkidul Regency were from the wife's lawsuit, namely 24 cases of divorce claims, while the lawsuit by the husband was only 7 cases. This can certainly be of particular concern.
"Decreasing as well, there have been only 1 to 3 years in the past. I happen to be the chairman of the assembly. But as mentioned before, observing the phenomenon of child marriage cannot only be seen from one perspective. Data on marriage dispensation requests are also indicators that can reveal a picture of the phenomenon that occurs.

-year dispensation for women and 19 years for men
Marriage dispensation is an application that must be submitted by a couple who wants to get married but has several obstacles, namely: (1) constraints on administrative registration time, and (2) constraints on the lack of age of the applicant to marry based on the provisions of Law No. 1 of 1974 concerning Marriage. The time constraints on administrative registration occur generally because the registrant wants to immediately get married while based on administrative provisions generally there must be a gap of 10 days after the registration is declared accepted by the KUA. This is done so that there is time for an announcement in KUA of candidates to be married in an effort to avoid conflict if it turns out that there are fake data such as falsifying the status of one of the prospective bride who claimed to be single even though he was married. If the applicant or prospective bride wants to hold a marriage with a faster time then it must file a dispensation. The second condition that requires Catin to submit dispensation is the problem of the lack of age of prospective bride according to the age standard stipulated in the Marriage Law, namely 16 years for women and 19 years for men.
The lack of age of the prospective bride who causes having to submit a marriage dispensation request is carried out while collecting the administrative requirements needed to register the marriage with the KUA. Afterward, if it is found that the age of the prospective bride is less than the provisions, the KUA will issue form N7 and N8 as a refusal which then prospective bride must register the marriage dispensation request to the Religious Court. the prospective bride had to attend a hearing at the Religious Court before finally getting a verdict from the judge whether or not the request was granted. If their request is granted by the judge, they can return to the KUA to be legally married.
The marriage dispensation data in table 3 does show a  number different from the marriage number in the  previous table, which is table 2. This does not necessarily imply that the existing data is not synchronous between agencies, but the application data for marriage dispensation does not necessarily represent the occurrence of the official marriage. It could be that the applicant is dispensing especially if it is his male party, so the marriage is outside the Gunungkidul Regency so that the marriage registration does not occur in Gunungkidul Regency but in the area of his bride even though the request for marriage dispensation is recorded in Gunungkidul Regency. In addition to this, there is also the possibility of a request that has been granted by the judge but is canceled by the bride and groom. There is also the possibility of a dispensation being submitted at the end of the year so that the marriage registration takes place the following year.
" Wslm. Iyah, among other things, does not have to be married in GK, it can be in other areas, especially those who are less of a husband's clone. Or it has also been given dispensation but not used. Or the expression of the end of the next year. "-Yosep Muniri, Former Head of KUA, Gedangsari District (via WhatsApp) From Table 3 above, it can be seen that the marriage dispensation request has a positive trend with the decline that occurred especially after 2015 which was the year the Perbup was ratified. However, if observed the decline began to occur in the previous year, namely since 2013, in which efforts to prevent child age marriages have actually been initiated at the sub-district level. Many factors that may have an impact, but in 2015 since it was passed declaring, the application for a dispensation to marry increasingly decreased quite significantly to the number of cases under 100.
In addition to this, the phenomenon of child age marriage can also be observed from the number of recorded teen births. This is because not all child-age marriages are officially recorded at the KUA or in the Ministry of Religion's data, sometimes there are underthe-hand marriages or illegal (sirri) marriage or cases of pregnancy out of wedlock that is not later married because of a change in the mindset of the woman herself immediately want to get married because they think that it is not always a way out.
" increased support, family support, social support is also good. "-Arum Rohayati, P2TP2A Psychological Counselor For this reason, the data on childbirth can also represent the phenomenon of child marriage. From the data obtained from sources from the Health Office, data on adolescent deliveries have decreased from year to year since the ratification of the Marriage Prevention Regulation for the Age of Children. Based on the existing indicators, it was found that the decline in child age marriage had begun to be seen from 2 years before the PPUA Regulation was ratified and enacted, this was suspected to be a contribution from efforts that had emerged in the sub-district. After the PPUA Regulation was ratified and put into effect in 2015, the decline was seen in several indicators increasingly showed a significant decline so that it can be said that the PPUA Regulation contributed to the role of PPUA efforts carried out in Gunungkidul District.

The effectiveness of Regent Regulation Practice
The effectiveness is seen from the comparison of the results of the efforts to prevent child age marriages with their goals based on the mandate contained in the Gunungkidul Regulation No. 36 of 2015 concerning Prevention of Marriage at the Age of Children (PPUA). Gunungkidul Regent Regulation No. 36 of 2015 concerning PPUA stipulated on July 24, 2015, has the following objectives: 1) guarantee the protection of children and the fulfillment of their rights so that children can live, grow and participate according to their dignity and dignity optimally, 2) make children as qualified human resources, have a noble character, and can live well, 3) minimize the occurrence of violence against children, 4) prevent domestic violence (domestic violence), 5) improve maternal and child health status in Gunungkidul Regency, 6) minimize the occurrence of dropouts, and 7) reduce poverty in the region.
The mandate was based on the fact that before the establishment of the Perbup, child marriages in Gunungkidul Regency were recorded to be quite high each year so that it was deemed to require a legal umbrella and carried out more institutionalized prevention efforts involving cross DPOs and agencies within the Gunungkidul Regency government.
The objectives contained in the PPUA Regulation are actually complex indicators, require in-depth study, and measurement is long-term. Indicators of increasing MCH status, for example, are contributions from many factors that cannot be assessed only from one side. In relation to PPUA, a number of indicators related to maternal and child health which can be collected include the trend of cases of unwanted pregnancies (UP) which decreased from data in 2015 which showed 236 cases of UP to as many as 121 cases of UP in 2016. UP is generally experienced by teenagers who do not want the pregnancy. However, the downward trend in UP cases from 2015 to 2016 provides a positive picture, seeing that 2015 was the first year of the implementation of the PPUA Regulation. Also based on the theory of early marriage link then the marriage age of children at risk for having a baby with status Infant Low Birth Weight (LBW) as one of the causes of maternal mortality and infant mortality. This happens because generally the nutritional status and readiness of the sexual organs of adolescent mothers are not ready for conception or pregnancy, so they usually affect the weight of children born. The trend of LBW cases based on data compiled by the Gunungkidul District Health Office also decreased after 2015 since the enactment of the Regulation. It is suspected that this is a contribution froPPUA's effort to contribute to the The stunting data that was collected was as follows:

Discussions
Preventing violence against women and children by preventing marriage at the age of the child is one of the ways that can be taken. From the data obtained, there is a trend that the cases of violence received by the relevant agencies show a good decline. Although cases of violence against children had risen in 2016 but continued to show a decline in the following year. More in-depth data analysis and a qualitative approach to analyzing cases of violence that occur are indeed needed to strengthen the analysis whether indeed the decline is a contribution to the reduction of child marriages, but this becomes a separate limitation in this study. If the phenomenon is proven then this is in line with research that states that child marriage is indeed related to the occurrence of violence in the form of sexual violence, physical violence, or psychological violence [11][12][13]. In the footnote of the data provided by DP3AKBPMD, it is stated that cases of child abuse are dominated by types of cases of sexual violence. Early marriage does increase the risk of physical violence by 34% and 21% for sexual violence 13 . There 32% of women married under the age of 15 experienced first forced sex [11].
Child marriage is clearly known to have an impact on the health status of a woman as a mother and for the child, she is born with. Some health impacts for women who have been studied and are related to underage marriage are complications of pregnancy, unwanted pregnancy, SEZ and anemia [3]. Some of the complications of pregnancy are because statistically young married women usually have poor reproductive health status [3]. This is in line with the statement from the Head of the Family Health & Community Nutrition Section, Gunungkidul District Health Office stating that after many screening after the implementation of the policy, many netted teenagers with anemia status or poor nutritional status.
Based on the data delivered, it can be seen that along with the decline in child marriage cases after the implementation of the PPUA Regulation, the number of unwanted pregnancies has decreased. Improving the quality of maternal and child health can also be observed from the decline in LBW cases that decrease every year after the PPUA policy is implemented. This is very possible because the better access of the community to health services is due to the obligation of the clinician to access pre-marital health services which at the same time provide space for health workers to detect high-risk groups and provide the assistance they need. In the theory of Early Marriage Link, LeFevre (2001) illustrates that early marriage contributes to the increased risk of maternal death and illness as well as the risk of infant mortality and illness, which even if a baby girl can survive the same cycle will repeat and continue to the next generation [14].
Child marriage is also suspected to cause anthropometric failure or anthropometric failure such as stunting, wasting, and underweight because women who marry young are more likely to have poor reproductive health status [3,15]. This study found that there was a tendency to decrease the incidence of stunting in Gunungkidul Regency after the enactment of the PPUA Regulation. It can be seen that even since 2013 there has been a decline until in 2014 the decline showed more positive results. Increasing access to pre-marital health services by prospective brides to the Puskesmas as an administrative requirement for registering marriages is one factor. However, this policy in 2013 was only carried out in Gedangsari Sub-District as a PPUA pioneer. In 2015, unfortunately, there was an increase even though in 2016 there was a decline again. Data limitations and limitations of the study are the causes so that it cannot be done a more in-depth study of this phenomenon on the stunting indicator related to the decline in cases of child marriage.

Conclusion
In general, Regent Regulation No. 36/2015 concerning Marriage Prevention at the Age of Children gives a performance in decreasing the incidence of child marriage in Gunungkidul Regency. The effectiveness of this policy practice reflected since 2012 and believed to be a contribution from efforts that have emerged in the sub-district, after the PPUA Regulation was enacted and enacted in 2015 the achievement of several indicators such as the number of underage marriages, the number of marriage dispensation requests, and the number of teen births shows a significant decrease. The PPUA regulation is a package with the success that seems to have a positive externality by spreading enthusiasm for other regions to imitate the steps they take.