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Ghosh A, Mistri B. Socio-demographic and infrastructural variables influencing maternal risk concentration among ever-married women of reproductive age in rural West Bengal, India. Int J Health Plann Manage 2024; 39:1383-1410. [PMID: 38803039 DOI: 10.1002/hpm.3805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The risk of a woman dying as a result of pregnancy or childbirth during her lifetime is about one in six in the poorest parts of the world. OBJECTIVES The present study aims to determine prevalence of maternal risk and the influencing variables among ever-married women belonging to the reproductive age group (15-49) of Birbhum district, West Bengal. METHODS A cohort-based retrospective cross-sectional study was carried out among the sample of 229 respondents through a purposive stratified random sampling method and a pre-designed semi-structured questionnaire. The ordinal logistic regression (OLR) model was taken as a tool of assessment. Before developing the proportional OLR model, we have checked the multicollinearity effect among the predictors and the first-order effect modifier was evaluated as well. We performed data analysis using SPSS version 26. RESULTS The result shows that illiterate women (Odds ratios [OR] = 2.81, 95% CI, 0.277-1.791), from lower standard of living (OR = 1.14, 95% CI, -0.845-1.116), married before the age of 15 years (OR = 21.96, 95% CI, -0.55-6.73) and between the age of 15-18 years (OR = 24.51. 95% CI, -0.45-6.85) are more likely to be affected by the higher concentration of maternal risk. Other important predictor is the time of pregnancy registration. Considering the transport and related en-route causalities, the result portraying a clear picture where the distance and travel time becoming significant factors in determining the concentration of maternal risk. CONCLUSION Incidences of child marriages should be restricted. Eradicating factors influencing an individual's decision to seek care would be an essential contribution in excluding the dominant maternal risk factors.
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Affiliation(s)
- Alokananda Ghosh
- Department of Geography, Tehatta Sadananda Mahavidyalaya, Purba Bardhaman, West Bengal, India
| | - Biswaranjan Mistri
- Department of Geography, The University of Burdwan, Burdwan, West Bengal, India
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Mamun MA, Mahmud S, Antu JF, Talukder A, Naved RT. A protocol for a cluster randomized controlled trial to assess the impact of Balika Bodhu: A combined empowerment and social norm based sexual and reproductive health and rights intervention for married adolescent girls in rural Bangladesh. PLoS One 2024; 19:e0304988. [PMID: 39178272 PMCID: PMC11343452 DOI: 10.1371/journal.pone.0304988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/20/2024] [Indexed: 08/25/2024] Open
Abstract
INTRODUCTION Sexual and reproductive health and rights (SRHR) are vital for both individual well-being and development. Bangladesh has made long strides in improving SRHR over the last few decades. However, the progress has been uneven across various groups of reproductive-aged females, with the married adolescent girls (MAGs) often being more vulnerable to denial of SRHR than other women. This study intends to develop Balika Bodhu, a combined empowerment and social norm intervention for promoting SRHR among the MAGs and assess its impact. METHODS The evaluation will employ a mixed-method two-arm Cluster Randomized Controlled Trial (CRCT) design, where Arm 1 receives the intervention, and Arm 2 serves as the control. The trial will cover 32 clusters (villages) in Rajbari Sadar sub-district, randomized into two equally distributed study arms. A total of 1,120 MAGs aged 15-19 years will be randomly selected from the clusters (35 per cluster) to form a cohort. The MAGs, their husbands, selected elderly women (26 per village) and influential community members (26 per village) will receive group sessions in the intervention clusters. The MAGs and their husbands will be interviewed at baseline and endline. A randomly selected cross-sectional sample of community members aged 35-59 years at baseline and endline will also be surveyed to measure attitudes and social norm regarding SRHR of MAGs. Qualitative data will be collected using 32 In-depth Interviews, six Key Informant Interviews, and eight Focus Group Discussions from two intervention villages. Intention-to-treat (ITT) analysis will be performed to assess the impact of the intervention. Narrative analysis and the Grounded Theory approach will be used to analyze the qualitative data. CONCLUSION Rigorous evaluation of Balika Bodhu should contribute to the literature on what works and what does not in addressing denial of SRHR to MAGs using empowerment and social norm intervention and inform policies and programs. TRIAL REGISTRATION Clinicaltrials.gov: identifier: NCT06126770; Date: Oct 7, 2023. Version 1.
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Affiliation(s)
- Mahfuz Al Mamun
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Sultan Mahmud
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Aloka Talukder
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
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Marphatia AA, Saville NM, Manandhar DS, Cortina-Borja M, Wells JCK. Where have I got to? Associations of age at marriage with marital household assets in educated and uneducated women in lowland Nepal. PeerJ 2024; 12:e17671. [PMID: 39131621 PMCID: PMC11316463 DOI: 10.7717/peerj.17671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/12/2024] [Indexed: 08/13/2024] Open
Abstract
Background Women's underage marriage (<18 years) is associated with adverse maternal and child health outcomes. Poverty in the natal household has been widely considered to be a key risk factor for underage marriage, but the evidence base is unreliable. When investigating this issue, most studies use marital wealth inappropriately, as a proxy for wealth in the natal household. In contrast, we investigated whether the timing of women's marriage was associated with the wealth of the households they marry into, and how this may vary by women's education level. This approach allows us to explore a different set of research questions which help to understand the economic value placed on the timing of women's marriage. Methods We used data on 3,102 women aged 12-34 years, surveyed within 1 year of marriage, from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Linear mixed-effects regression models investigated independent associations of women's marriage age and education level with marital household wealth, and their interactive effects. Models adjusted for marital household traits. We analysed the full sample, and then only the uneducated women, who comprised a substantial proportion in our sample. Results In the full sample, we found that each later year of women's marriage was associated with 1.5% lower asset score for those with primary education, and with 0.3% and 1.3% higher asset score for those with lower secondary or secondary/higher education, respectively. For uneducated women, relative to marrying ≤14 years, marrying at 15, 16, 17 and ≥18 years was associated with 1.5%, 4.4%, 2.4% and 6.2% greater marital asset score respectively. Conclusion On average, marrying ≥18 years was associated with greater marital assets for secondary-educated women. There were only very modest benefits in terms of marital household wealth for delaying marriage beyond 16 years for uneducated women or those with low education. These findings elucidate potential trade-offs faced by families, including decisions over how much education, if any, to provide to daughters. They may help to understand the economic rationale underpinning the timing of marriage, and why early marriage remains common despite efforts to delay it.
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Affiliation(s)
- Akanksha A. Marphatia
- Population, Policy and Practice Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Naomi M. Saville
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Mario Cortina-Borja
- Population, Policy and Practice Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jonathan C. K. Wells
- Population, Policy and Practice Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Reisz T, Murray K, Gage AJ. Associations between child marriage and reproductive and maternal health outcomes among young married women in Liberia and Sierra Leone: A cross-sectional study. PLoS One 2024; 19:e0300982. [PMID: 38768254 PMCID: PMC11104668 DOI: 10.1371/journal.pone.0300982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Child marriage has been associated with a range of negative maternal and reproductive health outcomes. This study explored these associations in Liberia and Sierra Leone and examined how child marriage intersected with other measures of social disadvantage. METHODS Data were derived from 631 and 1,325 married or cohabitating women aged 20-24 interviewed in the 2019-2020 Liberia and 2019 Sierra Leone Demographic and Health Surveys, respectively. Analyses were stratified by country. Regression models examined associations between age at first marriage (<15, 15-17, and 18+ years) and reproductive and maternal health outcomes, as well as interactions between child marriage and measures of social disadvantage. Multivariable regression results were presented as adjusted odds ratios and 95% confidence intervals. RESULTS Over half of currently married/cohabitating women aged 20-24 in Liberia (52%) and Sierra Leone (54%) married before age 18, and over one in 10 married before age 15. In both countries, after adjusting for other factors, being married before the age of 18 was significantly associated with early fertility, high fertility, and low fertility control. Associations were particularly strong among women who first married before age 15. In Liberia, women who married at age 15-17 had significantly lower odds of skilled attendance at delivery and institutional delivery if they lived in the North Central region. Sierra Leonean women who married before age 15 had lower odds of institutional delivery and lower odds of four or more ANC visits if they lived in the North Western region. CONCLUSION This study found clear associations between child marriage and negative reproductive health outcomes in Liberia and Sierra Leone, with stronger associations among women married in early adolescence. Child marriage and region of residence intersected to shape young women's access to skilled attendance at birth and institutional delivery. These findings call for further investigation and targeted intervention.
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Affiliation(s)
- Taylor Reisz
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Kelly Murray
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Anastasia J. Gage
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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Amare T, Tessema F, Shaweno T. Determinants of unintended pregnancy and induced abortion among adolescent women in Ethiopia: Evidence from multilevel mixed-effects decomposition analysis of 2000-2016 Ethiopian demographic and health survey data. PLoS One 2024; 19:e0299245. [PMID: 38489318 PMCID: PMC10942086 DOI: 10.1371/journal.pone.0299245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 02/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Adolescents are highly at risk of unintended pregnancy due to physiological, sexual, social and psychological growth. The pregnancy may end with early childbirth, induced abortion and its complications. Although, the trends of unintended pregnancy and induced abortion have declined over time in Ethiopia, evidence is limited on key determinants for decline in order to propose vital areas of interventions. The current study aimed to identify the determinants of unintended pregnancy and induced abortion among adolescents over the decades. METHODS Trends in the prevalence of unintended pregnancy and induced abortion among adolescent women aged 15-19 years were investigated based using a series of the Ethiopia Demographic and Health Surveys (EDHS) data for the years 2000, 2005, 2011, and 2016. Sub-sample of adolescent women data was extracted from each survey. The combined datasets for unintended pregnancy and induced abortion over the study period (2000-2016) was analyzed. The percentage changes of trends of unintended pregnancy and induced abortion with its corresponding 95% CI for each variable were calculated. Multilevel mixed-effects decomposition analysis was applied to identify factors significantly associated with trends of unintended pregnancy and induced abortion among adolescents. RESULTS The trends of unintended pregnancy and induced abortion significantly declined during the study period. Unintended pregnancy among Ethiopian adolescents aged 15-19 years significantly decreased from 307 (41.4%) (95% CI: 35.7, 47.2%, p<0.001) in 2000 to 120 (25.1%) (95% CI: 18.9, 31.4%) in 2016. On the other hand, induced abortion significantly decreased from 62 (8.3%) (95% CI: 5.2, 11.4%) in 2000 to 20 (4.1%) (95% CI: 1.3, 6.9%, p = 0.004) in 2016. Age older than 18 years (Coeff = -0.41, 95%CI, -0.64, -0.18, p<0.001), living in Somali regional state (Coeff = -2.21, 95%CI, -3.27, -1.15, p<0.001) and exposure to media (Coeff = -0.60, 95%CI, -0.87, -0.33, p<0.001) showed a significance association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz regional state (Coeff = -0.17, 95%CI, -0.32, -0.19, p = 0.03) and ANC service utilization history (Coeff = -0.81, 95%CI, -1.45, -0.17, p = 0.01) showed significance association with decline in induced abortion. CONCLUSION The trends of unintended pregnancy and induced abortion significantly declined over the past decades in Ethiopia. Adolescent girls aged 17 years and above, exposure to media and living in Somali showed significant association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz and ANC service utilization history showed significant decline with induced abortion. Exposure to media and utilization of Antenatal care (ANC) services may improve adolescent girls' reproductive health uptake.
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Affiliation(s)
- Tiruwork Amare
- MSI Ethiopia, Reproductive Choices, Addis Ababa, Ethiopia
| | - Fasil Tessema
- Jimma University Institute of Health Department of Epidemiology, Jimma, Ethiopia
| | - Tamrat Shaweno
- Africa Centres for Diseases Control and Prevention, Addis Ababa, Ethiopia
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Das M, Patidar H, Singh M. Understanding trimester-specific miscarriage risk in Indian women: insights from the calendar data of National Family Health Survey (NFHS-5) 2019-21. BMC Womens Health 2024; 24:63. [PMID: 38263129 PMCID: PMC10804530 DOI: 10.1186/s12905-023-02838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/09/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The primary public health issue, especially in low- and middle-income countries, is early pregnancy loss driven by miscarriage. Understanding early pregnancy losses and the characteristics of mothers who have miscarriages is essential to creating effective reproductive health strategies. Thus, this study's primary goal is to delve into the factors which impact miscarriages that take place prior to and following the first 12 weeks of gestation. METHODS The bivariate analysis was employed to determine the frequency of miscarriages. The factors associated with miscarriages in the first (≤12 weeks) and second & above (> 12 weeks) trimesters of pregnancy were then examined using a generalised linear regression model, with 95% confidence intervals. Finally, we use ArcGIS to illustrate the prevalence of miscarriage in the districts of India. RESULTS Our result shows that miscarriages occur often in India (4.9%), with 23% of cases occurring in the first trimester (≤12 weeks). In our bivariate analysis, we identified several factors associated with a higher prevalence of miscarriages in India. It was found that mothers aged thirty years or older, residing in urban areas, with less than ten years of education, belonging to the richest wealth quantile, expressing a desire for more children, having no demand for contraception, and possessing no parity experienced a higher prevalence of miscarriage in total pregnancies in India. On the other hand, the generalised linear model's findings show that mothers who are thirty years of age or older, practise other religions, live in urban areas, are members of other castes, want more children, marry before the age of eighteen, and meet their contraceptive needs are more likely to have miscarriages in total pregnancy. However, there is a larger likelihood of miscarriage in the first trimester (≤12 weeks) for mothers who follow other religions, live in urban areas, are from Other Backward Class (OBC), get married before the age of eighteen, and fall into the middle and upper wealth quantiles. A mother is more likely to miscarriage in the second & above (> 12 weeks) trimesters if she is older than thirty, from other castes, wants more children, has moderate media exposure, marries before turning eighteen, meets her contraceptive needs, and does not feel the need for contraception. After accounting for socioeconomic characteristics, all results were statistically significant. CONCLUSIONS Given the substantial number of miscarriages in India, police need to improve planning and guidance in order to lower pregnancy loss due to miscarriage. Miscarriage rates may be significantly decreased by enhancing the availability and quality of reproductive health care infrastructure, particularly in rural areas.
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Affiliation(s)
- Milan Das
- International Institute for Population Sciences, Mumbai, India
| | | | - Mayank Singh
- International Institute for Population Sciences, Mumbai, India.
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Pru M, Brown CM, Singh RS. Cost of mate choice: Changing patterns of global age disparity in marriage and their consequences to women's health including maternal mortality and menopause. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241264687. [PMID: 39066558 PMCID: PMC11282549 DOI: 10.1177/17455057241264687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Consistent across cultures and throughout time is the male preference for younger females. Given its prevalence, the mate choice theory proposes that age-disparate relationships may have contributed to the evolution of maternal mortality and menopause. OBJECTIVES The objective is to document evidence for age disparity in marriage from past and present populations and evaluate their relevance to maternal mortality and menopause. DESIGN Cross-sectional data were collected from various regions and time points, ranging from the Roman era to the current decade. METHODS To analyze both the age disparity in marriage and age at marriage, data were collected from Ancestry.ca for Quebec, Massachusetts, India, South Africa, and England and Wales. Additional data were taken from the United Nations as a more recent and comprehensive source. To analyze the relationships between age disparity in marriage and different social factors, data on gross domestic product, maternal mortality rates, fertility, primary school enrollment, child marriage rates, and percentage of women in the total labor force were collected from the World Health Organization, World Bank, and United Nations International Children's Emergency Fund. RESULTS The results showed that males were significantly older than females at first marriage in all populations and time frames sampled, supporting the assumption underlying the mate choice theory. Maternal mortality rates were strongly associated with age-disparate relationships, increasing by 275 per 100,000 live births for each additional year in the age disparity. CONCLUSION The results from this study provide support for the assumption underlying the mate choice theory of maternal mortality and menopause.
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Affiliation(s)
- Mindy Pru
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - C Michelle Brown
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - Rama S Singh
- Department of Biology, McMaster University, Hamilton, ON, Canada
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Miller FA, Dulal S, Rai A, Gram L, Harris-Fry H, Saville NM. "Can't live willingly": A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002279. [PMID: 37871001 PMCID: PMC10593245 DOI: 10.1371/journal.pgph.0002279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/13/2023] [Indexed: 10/25/2023]
Abstract
In South Asia, early marriage has been associated with a range of adverse outcomes during pregnancy and infancy. This may partly be explained by early marriage leading to a younger maternal age, however it remains unclear which other factors are involved. This review aimed to synthesise the qualitative evidence on experiences of pregnancy following early marriage or early pregnancy in South Asia, to inform our understanding of the mechanisms between early marriage and adverse pregnancy outcomes. We searched MEDLINE, EMBASE, Scopus, Global Index Medicus, CINAHL, PsycINFO, Web of Science, and grey literature on 29/11/2022 to identify papers on experiences of pregnancy among those who married or became pregnant early in South Asia (PROSPERO registration number: CRD42022304336, funded by an MRC doctoral training grant). Seventy-nine papers from six countries were included after screening. We appraised study quality using an adapted version of the Critical Appraisal Skills Programme tool for qualitative research. Reporting of reflexivity and theoretical underpinnings was poor. We synthesised findings thematically, presenting themes alongside illustrative quotes. We categorised poor pregnancy experiences into: care-seeking challenges, mental health difficulties, and poor nutritional status. We identified eight inter-connected themes: restrictive social hierarchies within households, earning social position, disrupted education, social isolation, increased likelihood of and vulnerability to abuse, shaming of pregnant women, normalisation of risk among younger women, and burdensome workloads. Socioeconomic position and caste/ethnic group also intersected with early marriage to shape experiences during pregnancy. While we found differences between regions, the heterogeneity of the included studies limits our ability to draw conclusions across regions. Pregnancy experiences are largely determined by social hierarchies and the quality of relationships within and outside of the household. These factors limit the potential for individual factors, such as education and empowerment, to improve experiences of pregnancy for girls married early.
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Affiliation(s)
- Faith A. Miller
- Institute for Global Health, University College London, London, United Kingdom
| | - Sophiya Dulal
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Anjana Rai
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Lu Gram
- Institute for Global Health, University College London, London, United Kingdom
| | - Helen Harris-Fry
- Department of Population Health, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Naomi M. Saville
- Institute for Global Health, University College London, London, United Kingdom
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Pourtaheri A, Sany SBT, Aghaee MA, Ahangari H, Peyman N. Prevalence and factors associated with child marriage, a systematic review. BMC Womens Health 2023; 23:531. [PMID: 37817117 PMCID: PMC10565969 DOI: 10.1186/s12905-023-02634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Girl child marriage is increasingly recognized as a critical barrier to global public health and gender discrimination. There are still more gaps in the global rate of child marriage and the underlying factors. Thus, the present systematic review aimed to explore the prevalence of child marriage and the underlying factors. METHODS A comprehensive search was conducted for all English-language studies that measured the prevalence of child marriage and its correlates from 2000 to March 2022, indexed in PubMed, Scopus, Web of Science, Poplin, and Google Scholar databases. Child marriage is defined as marriage under the age of 18. In the present study, Joanna Briggs' quality assessment checklist was used for data collection. Two independent reviewers reviewed all the articles. RESULTS In total, 34 eligible prevalence articles and 14 trend articles were included in the study with data from 127,945 participants. The prevalence of child marriage ranged between 1.8% to 90.85%. In most studies, the trend of child marriage was decreasing. The most important individual factors include the respondent's education and occupation, interpersonal factors such as the education and occupation of parents and husband, family size and type. Community factors include socioeconomic status, region, residence, ethnicity, and religion at the social level. CONCLUSION Despite a central focus of research and policies on interventions that decrease child marriage, this phenomenon is still prevalent in many places. Therefore, further specific interventions are required to improve education, reduce poverty and inequality. This may help achieve the 2030 Sustainable Development Goals.
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Affiliation(s)
- Asma Pourtaheri
- Department of Health Promotion and Education, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Belin Tavakoly Sany
- Department of Health, Safety and Environment management (HSE), School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monavvar Afzal Aghaee
- Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamideh Ahangari
- Department of Health Promotion and Education, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nooshin Peyman
- Department of Health Promotion and Education, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
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Sajjad W, Ishaq K, Asghar S. Why Pakistani Women Do Not Use Intrauterine Contraceptive Devices: A Systematic Review of Barriers and Misconceptions. Cureus 2023; 15:e47378. [PMID: 38022103 PMCID: PMC10657553 DOI: 10.7759/cureus.47378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
This review explores barriers limiting the adoption of Intrauterine Contraceptive Devices (IUCDs) in Pakistan, focusing exclusively on local articles. As Pakistan's high population calls for widespread contraception, we aim to pinpoint obstacles hindering IUCD utilization, irrespective of parity. We conducted a comprehensive search of PubMed, Google Scholar, PakMedinet, and Wiley Online Library for English-language primary studies published between 2000 and 2022, reporting on IUCD utilization in Pakistan. Our analysis reveals multiple barriers impeding IUCD use in Pakistan. These encompass patriarchal social norms, male dominance, low education, socioeconomic status, and unemployment. Post-insertion health concerns, inadequate counseling, government commitment, and awareness were also identified barriers. Provider confidence, client trust, women's autonomy, social constraints, and limited male partner involvement hindered IUCD adoption. A desire for larger families and male offspring, vague religious beliefs, fear, and misconceptions further restricted usage. Accessibility and high service costs also posed challenges. This review highlights prevailing impediments to IUCD adoption in Pakistan, encompassing knowledge gaps, motivation deficits, resistance from husbands and in-laws, cultural and religious beliefs, limited access, and communication barriers. To promote IUCDs as a modern contraceptive method, it is essential to raise awareness among both men and women. Active involvement of religious leaders and community stakeholders is crucial in addressing these social factors hindering IUCD utilization.
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Affiliation(s)
- Waseem Sajjad
- Department of Community Medicine and Public Health, Mayo Hospital, Lahore, PAK
| | - Khadija Ishaq
- Department of Community Medicine and Public Health, Mayo Hospital, Lahore, PAK
| | - Sunaina Asghar
- Department of Community Medicine and Public Health, Mayo Hospital, Lahore, PAK
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Abstract
Eliminating child marriage is seen by policy makers and advocates as a path toward reducing births to girls below age 18, as most early births have been previously found to occur within marriage. There has been little recent evidence, however, of the marital context in which early childbearing occurs or how this relationship varies across space and levels of development. Using survey and vital registration data covering approximately 95 percent of the world's births to mothers younger than 18 years, we estimated the share of first births that occur within marriage at the global, regional and national levels. We found that more than half of births to mothers below age 18 worldwide take place in sub-Saharan Africa, and this share will continue to grow. Globally, 76 percent of first births to mothers below age 18 occur within marriage and there are large regional differences. Over the past two decades, the share of first births to mothers below age 18 occurring within marriage declined in most countries with data available, but there are important exceptions. Although most first births to women below age 18 occur following seven months of marriage, the sequencing of child marriage and early childbearing varies widely across countries.
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Affiliation(s)
- Joseph Molitoris
- is an Associate Population Affairs Officer, Population Division, United Nations Department of Economic and Social Affairs, New York, New York, USA
| | - Vladimíra Kantorová
- is a Population Affairs Officer, Population Division, United Nations Department of Economic and Social Affairs, New York, New York, USA
| | - Sehar Ezdi
- is an Associate Population Affairs Officer, Population Division, United Nations Department of Economic and Social Affairs, New York, New York, USA
| | - Giulia Gonnella
- is an Associate Population Affairs Officer, Population Division, United Nations Department of Economic and Social Affairs, New York, New York, USA
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Lee KH, Chowdhury AI, Rahman QSU, Cunningham SA, Parveen S, Bari S, El Arifeen S, Gurley ES. Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: Findings from a health and demographic surveillance system. PLoS One 2023; 18:e0288746. [PMID: 37467226 DOI: 10.1371/journal.pone.0288746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
Adolescent pregnancies, a risk factor for obstetric complications and perinatal mortality, are driven by child marriage in many regions of South Asia. We used data collected between 2017-2019 from 56,155 married adolescents and women in a health and demographic surveillance system to present a population-level description of historical trends in child marriage from 1990-2019 as well as epidemiologic associations between maternal age and pregnancy outcomes in Baliakandi, a rural sub-district of Bangladesh. For pregnancies identified between 2017-2019, we used Kaplan-Meier estimates to examine timing of first pregnancies after first marriage and multinomial logistic regression to estimate associations between maternal age and perinatal death. We described the frequency of self-reported obstetric complications at labor and delivery by maternal age. In 1990, 71% of all marriages were to female residents under 18 years of age. This decreased to 57% in 2010, with the largest reduction among females aged 10-12 years (22% to 3%), and to 53% in 2019. Half of all newly married females were pregnant within a year of marriage, including adolescent brides. Although we observed a decline in child marriages since 1990, over half of all marriages in 2019 were to child brides in Baliakandi. In this same population, adolescent pregnancies were more likely to result in obstetric complications (13-15 years: 36%, 16-17 years: 32%, 18-34 years: 23%; χ2 test, p<0.001) and perinatal deaths (13-15 years: stillbirth OR 2.23, 95% CI 1.01-2.42; 16-17 years: early neonatal death OR 1.57, 95% CI: 1.01-2.42) compared to adult pregnancies. Preventing child marriage can improve the health of girls and contribute to Bangladesh's commitment to reducing child mortality.
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Affiliation(s)
- Kyu Han Lee
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | | | - Solveig A Cunningham
- Department of Global Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Sanwarul Bari
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Emily S Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Batyra E, Pesando LM, Castro AF, Furstenberg FF, Kohler HP. Union formation, within-couple dynamics, and child well-being: A global macrolevel perspective. POPULATION, SPACE AND PLACE 2023; 29:e2661. [PMID: 37635738 PMCID: PMC10454532 DOI: 10.1002/psp.2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/29/2023] [Indexed: 08/29/2023]
Abstract
Studies on global changes in families have greatly increased over the past decade, adopting both a country-specific and, more recently, a cross-national comparative perspective. While most studies are focused on the drivers of global changes in families, little comparative research has explored the implications of family processes for the health and well-being of children. This study aims to fill this gap and launch a new research agenda exploring the intergenerational implications of union-formation and within-couple dynamics for children's health and well-being across low- and middle-income countries (LMICs), both globally, regionally, and by the stage of fertility transition. We do so by adopting a macro-level perspective and a multi-axis conceptualization of children's outcomes - health at birth, health in later life, and schooling - and leveraging Demographic and Health Survey and World Bank data across 75 LMICs. Our results show that in societies where partnerships are characterized by more equal status between spouses - i.e., where the age range between spouses and differences in years of schooling between partners are narrower - children fare better on several outcomes. These associations are particularly strong in mid- and high-fertility settings. Despite a series of regularities, our results also highlight a set of findings whereby, at a macro-level, the prevalence of marriage and divorce/separation are not invariably associated with children's outcomes, especially in LMICs where fertility is comparatively lower. We document little cross-regional heterogeneity, primarily highlighting the centrality of demographic factors such as age vis-à-vis, for instance, region-specific characteristics that are more tied to the social fabric of specific societies.
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Affiliation(s)
- Ewa Batyra
- Center for Demographic Studies (CED-CERCA), Carrer de Ca n'Altayó, Edifici E2, 08193, Barcelona, Spain
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Yount KM, Durr RL, Bergenfeld I, Sharma S, Clark CJ, Laterra A, Kalra S, Sprinkel A, Cheong YF. Impact of the CARE Tipping Point Program in Nepal on adolescent girls' agency and risk of child, early, or forced marriage: Results from a cluster-randomized controlled trial. SSM Popul Health 2023; 22:101407. [PMID: 37251506 PMCID: PMC10214831 DOI: 10.1016/j.ssmph.2023.101407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/31/2023] Open
Abstract
Background Girl child, early, and forced marriage (CEFM) persists in South Asia, with long-term effects on well-being. CARE's Tipping Point Initiative (TPI) sought to address the gender norms and inequalities underlying CEFM by engaging participant groups on programmatic topics and supporting community dialogue to build girls' agency, shift power relations, and change norms. We assessed impacts of the CARE TPI on girls' multifaceted agency and risk of CEFM in Nepal. Methods The quantitative evaluation was a three-arm, cluster-randomized controlled trial (control; Tipping Point Program [TPP]; Tipping Point Plus Program [TPP+] with emphasized social-norms change). Fifty-four clusters of ∼200 households each were selected from two districts (27:27) with probability proportional to size and randomized evenly to study arms. A pre-baseline census identified unmarried girls 12-16 years (1,242) and adults 25 years or older (540). Questionnaires covered marriage; agency; social networks/norms; and discrimination/violence. Baseline participation was 1,140 girls and 540 adults. Retention was 1,124 girls and 531 adults. Regression-based difference-in-difference models assessed program effects on 15 agency-related secondary outcomes. Cox-proportional hazard models assessed program effects on time to marriage. Sensitivity analyses assessed the robustness of findings. Results At follow-up, marriage was rare for girls (<6.05%), and 10 secondary outcomes had increased. Except for sexual/reproductive health knowledge (coef.=.71, p=.036) and group membership (coef.=.48, p=.026) for TPP + versus control, adjusted difference-in-difference models showed no program effects on secondary outcomes. Results were mostly unmoderated by community mean: gender norms, household poverty, or women's schooling attainment. Cox proportional hazard models showed no program effect on time-to-marriage. Findings were robust. Discussion Null findings of the Nepal TPI may be attributable to low CEFM rates at follow-up, poor socio-economic conditions, COVID-19-related disruptions, and concurrent programming in control areas. As COVID-19 abates, impacts of TPP/TPP + on girls' agency and marriage, alone and with complementary programming, should be assessed. Trial registration number NCT04015856.
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Affiliation(s)
- Kathryn M. Yount
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
- Department of Sociology, Emory College of Arts and Sciences, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Robert L. Durr
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Irina Bergenfeld
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Sudhindra Sharma
- Interdisciplinary Analysts (IDA), Chandra Binayak Marg, Lampokhari, Chabahill, Kathmandu, 44600, Nepal
| | - Cari Jo Clark
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Anne Laterra
- CARE, USA, 151 Ellis Street NE, Atlanta, GA, 30303, USA
| | - Sadhvi Kalra
- CARE, USA, 151 Ellis Street NE, Atlanta, GA, 30303, USA
| | - Anne Sprinkel
- CARE, USA, 151 Ellis Street NE, Atlanta, GA, 30303, USA
| | - Yuk Fai Cheong
- Department of Psychology, Emory College of Arts and Sciences, 36 Eagle Row, Atlanta, GA, 30322, USA
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Singh M, Shekhar C, Shri N. Patterns in age at first marriage and its determinants in India: A historical perspective of last 30 years (1992-2021). SSM Popul Health 2023; 22:101363. [PMID: 36852378 PMCID: PMC9958403 DOI: 10.1016/j.ssmph.2023.101363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
Reproductive health and well-being of a woman are associated with factors such as menarche, first marriage, first sex, first birth, and menopause. The beginning of these events also brings about significant changes in women's lives. Despite marrying early being acknowledged as a detrimental and discriminatory socio-cultural global practice, a huge proportion of girls are being married at an early age, often detrimental to maternal and child health. Adding to the current national debate for the revision of the minimum age at marriage for girls from 18 to 21 years it becomes important to understand the past scenario and current situation of age at marriage in India. In this study, first five rounds of the National Family Health Survey (NFHS) have been used as a data source. Cox Proportional Hazard Model, Multiple Classification Analysis (MCA), Kaplan Meier Curve, Life table survival analysis, hierarchical clustered heat map, Multivariate Decomposition Analysis (MDA), and geospatial mapping were used to fulfill the objective of the study. The results showed that almost 65.9% of women got married before reaching the age of 18 years in the year 1992-93 which reduced to 23.2% among women aged 20-24 years in 2019-21. Region, respondent's level of education, caste, religion, wealth, and mass media exposure were significantly associated with the age at first marriage. The hazard of age at marriage declined significantly with higher educational attainment [higher education- AHR:0.37; CI:0.36 to 0.37], improving household wealth [richest wealth- AHR:0.91; CI:0.90 to 0.91], and mass media exposure [AHR:0.96; CI:0.95 to 0.96]. Since, the age at marriage has a substantial impact on fertility pattern and has a strong association with maternal & child health, policies regarding improving the age at marriage and better enforcement of the concerned laws are required to meet the SDG targets.
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Affiliation(s)
- Mayank Singh
- Department of Fertility & Social Demography, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
| | - Chander Shekhar
- Department of Fertility & Social Demography, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
| | - Neha Shri
- Department of Survey research and Data analytics, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
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Ospina Galeano D, Orozco F, Urquia ML. Child marriage and perinatal health in Ecuador, 2015-2020. Salud Colect 2023; 19:e4325. [PMID: 37311140 DOI: 10.18294/sc.2023.4325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/17/2023] [Indexed: 06/15/2023] Open
Abstract
This study sought to estimate the prevalence and distribution of newborns to mothers under age 18 in Ecuador and the association between perinatal indicators and maternal marital status. Newborn records obtained from Ecuador's Instituto Nacional de Estadísticas y Censos (INEC) between 2015 and 2020 were used to assess the joint association between maternal age groups (10-15, 16-17, 18-19, and 20-24 years) and marital status (married, common-law, and single) with low birthweight, preterm birth, and inadequate prenatal care. The prevalence of newborns to mothers under age 18 was 9.3% overall, but declined over the study period, drastically among married mothers. The association between marital status and perinatal indicators depended on maternal age. The more favorable outcomes observed among married mothers aged 20-24 years (compared to their single counterparts) weaken or disappear among mothers under age 18. Mothers in stable unions exhibited outcomes in between those of married and single mothers.
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Affiliation(s)
- Dorian Ospina Galeano
- Gerente de Sistemas de Información en Salud. Estudiante, Community Health Sciences (MSc), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canadá
| | - Fadya Orozco
- Doctora en Salud Pública. Docente Titular, Escuela de Salud Pública, Universidad San Francisco de Quito, Quito, Ecuador
| | - Marcelo Luis Urquia
- PhD in Epidemiology. Associate Professor, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canadá
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Mehari H, Haile F, Habtezghi S, Mulugeta Y, Abraham G, Berhe M, Abdu N. Determinants of Child Marriage and Its Related Adverse Health Outcomes Among Married Women in Sub-Region of Serejeka, Central Region in Eritrea: A Cross-Sectional Study. Int J Womens Health 2023; 15:215-224. [PMID: 36816453 PMCID: PMC9930585 DOI: 10.2147/ijwh.s389939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023] Open
Abstract
Background Child marriage is a fundamental violation of human rights that can have numerous adverse effects on girls' social, mental and physical health and wellbeing. Marriage in Eritrea relatively occurs earlier for women. This study aimed to assess the magnitude of child marriage, determinants and its related adverse health outcomes in five selected villages of the sub-region of Serejeka in Central region of Eritrea. Methods An analytical cross-sectional study was conducted among 200 married women aged 18 to 30 years who are residents of five selected villages of the sub-region of Serejeka between July 12 and August 20, 2018. The sampling design was stratified random sampling and data were collected using an interview-based questionnaire. Descriptive and analytical statistics including chi-square test and logistic regression were employed using SPSS (v.22). Results The prevalence of child marriage was found to be 42% [95% CI (35.1, 48.9)]. The maximum and minimum age at marriage were 14 and 29, respectively. No formal education/primary level (AOR = 22.08, 95% CI: 4.16, 117.24), junior educational level (AOR = 6.95, 95% CI: 3.48, 13.87) and decision on the marriage (AOR = 4.30, 95% CI: 1.03, 17.92) were the significant determinants of child marriage. Prolonged labour (OR = 2.81, 95% CI: 1. 32, 5.98), abortion (OR = 3.95, 95% CI: 1.63, 9.53), hemorrhage during birth (OR = 4.83, 95% CI: 1.68, 13.87), spousal violence (OR = 2.07, 95% CI: 1.15, 3.75), pressure/stress (OR = 4.83, 95% CI: 1.68, 13.87), termination of education (OR = 8.24, 95% CI: 4.35, 15.63) and stigma or isolation from their society (OR = 7.38, 95% CI: 3.03, 17.98) were significant adverse health outcomes associated with child marriage. Conclusion This study revealed that child marriage was still a common practice. It is associated with detrimental physical health, psychological well-being and socio-economic status. This mandates policy makers and program managers to focus their programs on delaying entry of children into wedlock and motherhood by providing information, education and enhancing communication with their community.
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Affiliation(s)
- Hanibal Mehari
- School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
| | - Feven Haile
- School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
| | - Sador Habtezghi
- School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
| | - Yuel Mulugeta
- School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
| | - Gebru Abraham
- School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
| | - Michael Berhe
- National Health Observatory, Ministry of Health, Asmara, Eritrea
| | - Nuru Abdu
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
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Prevalence and correlates of adolescent pregnancy, motherhood and adverse pregnancy outcomes in Uttar Pradesh and Bihar. BMC Pregnancy Childbirth 2023; 23:66. [PMID: 36703105 PMCID: PMC9878888 DOI: 10.1186/s12884-023-05354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023] Open
Abstract
Pregnancy during adolescence is a major risk factor for adverse pregnancy outcomes. Further, Motherhood during the adolescent period is identified as a major global health burden. Considering the widely known importance of the negative impact of adolescent pregnancy, motherhood at an early age, and adverse pregnancy outcomes, this paper aims to provide insight into correlates of teen pregnancy, adolescent motherhood and adverse pregnancy outcome. This study utilizes the data from UDAYA survey conducted in Uttar Pradesh and Bihar. The eligible sample size for the study was 4897 married adolescent girls between the ages of 15 and 19 years. Bivariate analysis with a chi-square test of association and Multivariable logistic regression analysis was performed to fulfill the aim of the study. Our study shows that a major proportion of married adolescents (61%) got pregnant before the age of 20 years and around 42% of all adolescent married women gave birth to a child before reaching the age of 20 years. Adolescents who married before the age of 18 years were 1.79 times more likely to experience pregnancy (OR: 1.79; CI: 1.39-2.30) and 3.21 times more likely to experience motherhood (OR: 3.21; CI: 2.33-4.43). In the present study, women who experienced physical violence were at higher risk for having an adverse pregnancy outcome (OR: 1.41; CI: 1.08-1.84) than those who did not experience physical violence. To conclude, regional and national level efforts focused on improving early marriage, education and empowering women and girls can be beneficial.
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Phiri M, Musonda E, Shasha L, Kanyamuna V, Lemba M. Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis. BMC Womens Health 2023; 23:21. [PMID: 36650478 PMCID: PMC9843915 DOI: 10.1186/s12905-023-02168-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Child marriage has long been a public health concern around the world, because it has the potential to deprive adolescent girls of their sexual reproductive health rights and limits their ability to reach their full potential in life. The prevalence of child marriage has been consistently higher in sub-Saharan Africa than elsewhere. However, fewer studies have explored the influence of both individual and community-level influences on early marriage in sub-Saharan Africa. This study, therefore, examined individual and community-level factors associated with child marriages in Zambia. METHODS Data came from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013-14 and 2018. A pooled weighted sample of 9990 women aged 20-29 years was used in the analysis. Stata software version 17 was used to perform statistical analysis, taking into account complex survey design. The association between individual- and community- level factors and early marital behavior was assessed using multilevel logistic regression models. RESULTS The prevalence of child marriage among women aged 20-29 was 44.4 percent (95% CI: 42.1, 46.7) in 2018, declining from 51.5 percent (95% CI: 48.9, 54.0) in 2007. Women with secondary or higher level of education [aOR = 0.36, 95% CI = 0.26-0.49] and [aOR = 0.07, 95% CI = 0.03-0.18] and those whose age at first birth was (15-19 year) or (20-29 years) were associated with less likelihood of experiencing child marriage. Communities with a high percentage of women who gave birth at a young age [aOR = 1.36, 95% CI = 1.15-1.62] were more likely to experience child marriage. Individual and community-level characteristics accounted for 35% of the overall variations in communities' likelihood of experiencing early marriage. Even after controlling for both individual and community-level influences, the intra-class correlation revealed that around 4.5 percent of the overall variations remained unexplained. CONCLUSION Prevalence of child marriage has reduced over the years but is still high in Zambia. Both individual and community- level factors influenced child marriage in Zambia. There is a need to strengthen strategies that keep girls in school to delay their exposure to early sexual debut and child marriage. Designing of reproductive health interventions in the country should consider integration of community factors such as economic insecurity and access to reproductive health information.
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Affiliation(s)
- Million Phiri
- grid.12984.360000 0000 8914 5257Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia ,grid.11951.3d0000 0004 1937 1135Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emmanuel Musonda
- grid.12984.360000 0000 8914 5257Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Liness Shasha
- grid.12984.360000 0000 8914 5257Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Vincent Kanyamuna
- grid.12984.360000 0000 8914 5257Department of Development Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Musonda Lemba
- grid.12984.360000 0000 8914 5257Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
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Child Marriage and Later-Life Risk of Obesity in Women: A Cohort Analysis Using Nationally Representative Repeated Cross-Sectional Data from Tajikistan. WOMEN 2023. [DOI: 10.3390/women3010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Child marriage, defined as union before age 18 years, has detrimental health and socioeconomic consequences. This study examines whether women married as children have a disproportionately higher risk of being obese at adulthood compared to their peers married as adults. Using data from the 2012 and 2017 waves of the Tajikistan Demographic and Health Survey, we matched women aged 25 to 49 years by birth year and month to create four birth cohorts. We fitted multivariable logistic regressions to assess the differential odds of being obese and estimated simultaneous quantile regression models to examine the differences in average body mass index (BMI) between women married as adults and as children within birth cohorts. We found that the adjusted odds of being obese for women married as children were 1.5 (CI: 1.3–1.7) times those of those who were married as adults, after controlling for sociodemographic correlates along with birth cohort and survey wave fixed effects. Results of the quantile regression analyses suggest higher expected BMI levels among women married as children compared to those of women married as adults across different quantiles of BMI. The differences though were more pronounced in the younger cohorts than in the older cohorts.
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Association between women's empowerment and diarrhoea in children under five years: evidence from the 2017/18 Benin Demographic and Health Survey. J Biosoc Sci 2023; 55:35-54. [PMID: 34814972 DOI: 10.1017/s002193202100064x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Globally, diarrhoea is the third leading cause of death for under five-children. Women's empowerment can significantly reduce under-five mortality due to diarrhoea. This study investigated the association between women's empowerment and childhood diarrhoea in Benin using data from the 2017/18 Benin Demographic and Health Survey. A total of 7979 currently married women were included in the study. A logistic regression model was used to control for possible confounders. The prevalence of diarrhoea among children under five years of age was 13.6%. About 36.3% of the currently married women decided either alone or together with their husband on their own health, purchase of large household items and visiting family/relatives. Close to 65.4% of currently married women disagreed with all five reasons to justify wife-beating. The children of mothers who had decision-making power were less likely to have diarrhoea (aOR = 0.74, 95% CI: 0.57-0.96) than the children of mothers who had no decision-making power. Moreover, the children of mothers who disagreed with all five reasons to justify wife-beating (aOR = 0.79, 95% CI: 0.65-0.96) were less likely to have diarrhoea than the children of mothers who accepted wife-beating as a part of life. Women's age, educational level, wealth index and region were associated with childhood diarrhoea in Benin. The role of women's empowerment, as determined by decision-making power and wife-beating attitude, was found to be significantly associated with the risk of childhood diarrhoea in Benin, after adjusting for other variables. Therefore, it is essential for policymakers in Benin to reinforce strategies and interventions focusing on women's empowerment to avert childhood mortality caused by diarrhoea. This includes improving household economic status, women's education and decision-making power and enhancing awareness of women's human and democratic rights.
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Urquia ML, Batista R, Grandi C, Cardoso VC, Orozco F, Fafard St. Germain AA. Associations between child and adolescent marriage and reproductive outcomes in Brazil, Ecuador, the United States and Canada. BMC Public Health 2022; 22:1410. [PMID: 35871000 PMCID: PMC9308908 DOI: 10.1186/s12889-022-13766-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although marriage is associated with favourable reproductive outcomes among adult women, it is not known whether the marriage advantage applies to girls (< 18 years). The contribution of girl child marriage (< 18 years) to perinatal health is understudied in the Americas. Methods National singleton birth registrations were used to estimate the prevalence of girl child marriage among mothers in Brazil (2011–2018, N = 23,117,661), Ecuador (2014–2018, N = 1,519,168), the USA (2014–2018, N = 18,618,283) and Canada (2008–2018, N = 3,907,610). The joint associations between marital status and maternal age groups (< 18, 18–19 and 20–24 years) with preterm birth (< 37 weeks), small-for-gestational age (SGA < 10 percentile) and repeat birth were assessed with logistic regression. Results The proportion of births to < 18-year-old mothers was 9.9% in Ecuador, 8.9% in Brazil, 1.5% in the United States and 0.9% in Canada, and marriage prevalence among < 18-year-old mothers was 3.0%, 4.8%, 3.7% and 1.7%, respectively. In fully-adjusted models, marriage was associated with lower odds of preterm birth and SGA among 20–24-year-old mothers in the four countries. Compared to unmarried 20–24-year-old women, married and unmarried < 18-year-old girls had higher odds of preterm birth in the four countries, and slightly higher odds of SGA in Brazil and Ecuador but not in the USA and Canada. In comparisons within age groups, the odds of repeat birth among < 18-year-old married mothers exceeded that of their unmarried counterparts in Ecuador [AOR: 1.99, 95%CI: 1.82, 2.18], the USA [AOR: 2.96, 95%CI: 2.79, 3.14], and Canada [AOR: 2.17, 95%CI: 1.67, 2.82], although minimally in Brazil [AOR: 1.09, 95%CI: 1.07, 1.11]. Conclusions The prevalence of births to < 18-year-old mothers varies considerably in the Americas. Girl child marriage was differentially associated with perinatal health indicators across countries, suggesting context-specific mechanisms.
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Seidu AA, Ahinkorah BO, Ameyaw EK, Budu E, Yaya S. Women empowerment indicators and uptake of child health services in sub-Saharan Africa: a multilevel analysis using cross-sectional data from 26 countries. J Public Health (Oxf) 2022; 44:740-752. [PMID: 34059913 DOI: 10.1093/pubmed/fdab177] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/21/2021] [Accepted: 05/11/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The sustainable development goal 3, target 2, seeks to reduce under-five mortality to as low as 25 deaths per 1000 live births by 2030. As such, seeking child health services has become a priority concern for all countries, particularly those in sub-Saharan Africa (SSA). Evidence suggests that empowered women are more likely to seek child health services. Hence, this study examined the association between women empowerment indicators and uptake of child health services in SSA. METHODS The study used data from the Demographic and Health Surveys of 26 SSA countries, which were conducted between 2010 and 2019. Two different samples were considered in the study: a total of 12 961 children within the vaccination age of 12-23, and 9489 children under age 5 with diarrhoea symptoms in the last 2 weeks before the survey. Women empowerment indicators comprised disagreement with reasons to justify wife beating, decision-making power and knowledge level, while child health services constituted complete vaccination uptake and seeking diarrhoea treatment. Frequencies, percentages and multivariable, multilevel binary logistic regression models were employed. RESULTS The study shows that women with high decision-making power [adjusted odds ratio (AOR) = 1.20, 95% confidence interval (CI) = 1.07, 1.35] had higher odds of seeking treatment for childhood diarrhoea compared to those with low decision-making power. It was also observed that among children aged 12-23 months [AOR = 1.28, 95% CI = 1.14, 1.43], mothers had higher odds of seeking diarrhoea treatment for them compared to those who were aged less than 12 months. Children whose mothers had medium decision-making power [AOR = 1.30, 95% CI = 1.19, 1.41] were more likely to seek complete immunization for their children compared to those with low decision-making power. Also, those with medium [AOR = 1.19, 95% CI = 1.07, 1.31] and high knowledge [AOR = 1.25, 95% CI = 1.10, 1.42] had higher odds of completing immunization for their children compared to those with low knowledge. Women with medium acceptance had lower odds [AOR = 0.76, 95% CI = 0.67, 0.83] of completing immunization for their children compared with those with low acceptance of wife beating. CONCLUSIONS This study has demonstrated a strong association between women empowerment indicators and the uptake of child health services. Therefore, efforts should be made to seek policy tools to empower women to help improve the well-being of women and the children they care for.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Private Bail Box, UCC, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Services, James Cook University, QLD 4811, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney NSW 2007, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney NSW 2007, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Private Bail Box, UCC, Cape Coast, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa ON K1N 6N5, Canada.,The George Institute for Global Health, Imperial College London, London W12 OBZ UK, UK
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Bagade T, Chojenta C, Harris M, Oldmeadow C, Loxton D. The human right to safely give birth: data from 193 countries show that gender equality does affect maternal mortality. BMC Pregnancy Childbirth 2022; 22:874. [PMID: 36424537 PMCID: PMC9685845 DOI: 10.1186/s12884-022-05225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While a reduction in the global maternal mortality ratio (MMR) has slowed, newer strategies are needed to achieve an ongoing and sustainable reduction of the MMR. Previous studies have investigated the association between health system-related factors such as wealth inequalities, healthcare access and use on maternal mortality. However, a women's rights-based approach to address MMR has not been studied, excluding the health system-related factors. This study aimed to analyse the association between gender equality and MMR globally. METHODS Using structural equation modelling (SEM), secondary and open access data from the United Nations and other international agencies from 193 countries were analysed using structural equation modelling (SEM). Gender-sensitive variables that represented the theoretical, conceptual framework of the study were selected. The association between latent variable gender equality and the outcome, MMR, was examined in the SEM. A second SEM model (n = 158) was designed to include two variables related to gender-based violence. FINDINGS The latent variable, gender equality, was negatively associated with MMR (p < 0‧001, Z = -6‧96, 95% CI: - 6508.98 to - 3141.89 for Model 1 and p < 0‧001, Z = -7‧23, 95% CI: - 6045.356 to - 3467.515 for Model 2). INTERPRETATION Gender equality was significantly associated with maternal mortality. Investing in higher education for women, improving their paid employment opportunities, increasing participation in leadership roles and politics, reducing intimate partner violence (IPV) and ending child marriage can significantly reduce maternal mortality.
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Affiliation(s)
- Tanmay Bagade
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
| | - Catherine Chojenta
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
| | - Melissa Harris
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
| | - Christopher Oldmeadow
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Clinical Research Design, IT and Statistical Support (CReDITSS), Level 4 West (Public Health), HMRI Building, NSW 2305 New Lambton Heights, Australia
| | - Deborah Loxton
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
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Subramanee SD, Agho K, Lakshmi J, Huda MN, Joshi R, Akombi-Inyang B. Child Marriage in South Asia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15138. [PMID: 36429857 PMCID: PMC9691026 DOI: 10.3390/ijerph192215138] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Background: Child marriage is a serious public health issue with dire implications at the individual and societal level. Almost half of all child marriages globally originate from South Asia. The aim of this study is to identify consistent factors associated with and resulting from child marriage in South Asia through a review of available evidence. Methods: This systematic review adhered to the 2015 Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, namely PsycINFO, CINAHL, EMBASE, Ovid Medline, PUBMED, and Scopus were searched. Retrieved studies were exported to EndNote and screened for eligibility using pre-determined criteria. The quality of the included studies was rated using 14 quality appraisal criteria derived from the National Institutes of Health (NIH) Tool. Results: A total of 520 articles were retrieved from six databases. Of these, 13 articles met the eligibility criteria and were included in this study. Factors consistently associated with child marriage in South Asia were rural residence, low level of education, poor economic background, low exposure to mass media and religion (Hindu and Muslim in particular countries). Maternal health care factors resulting from child marriage included: low utilization of antenatal care services, low institutional delivery, and low delivery assistance by a skilled birth attendant. Conclusions: Child marriage results from an interplay of economic and social forces. Therefore, to address the complex nature of child marriage, efforts targeting improvement in education, employment, exposure to health information via mass media, and gender egalitarianism are required. This systematic review was registered with PROSPERO [CRD42020190410].
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Affiliation(s)
- S Daarwin Subramanee
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Kingsley Agho
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Josyula Lakshmi
- The George Institute for Global Health, Hyderabad 500 082, India
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, India
| | - Md. Nazmul Huda
- ARCED Foundation, Dhaka 1216, Bangladesh
- Translational Health Research Institute, Western Sydney University, Campbeltown, NSW 2560, Australia
| | - Rohina Joshi
- The George Institute for Global Health, Hyderabad 500 082, India
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
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Binyamini IM, Shoshana A. "I wanted to be a bride, not a wife": Accounts of child marriage in the Bedouin community in Israel. Transcult Psychiatry 2022; 60:357-367. [PMID: 36384329 DOI: 10.1177/13634615221135936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article presents a qualitative study of the experience of child marriage among Bedouin in Israel. We conducted semi-structured interviews with a convenience sample of 17 young Bedouin women, aged 17-21, who were married between the ages of 12-17. The interviewees' descriptions indicate that child marriage is a powerful cultural practice that has evolved into a "natural" and "obvious" tool for supervising girls and women. All the interviewees reported domestic violence, despair, and reported suicide attempts as a response to their existential suffering in their marriage and as an act of daily resistance to a powerful and oppressive cultural practice. These findings raise challenges in the case of global mental health interventions since these interventions not only require cultural sensitivity to avoid the constraint of Western psychiatric diagnoses and classifications, but also more critical thinking about the interactions between global and local, universalist and culturalist perspectives.
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Fafard St-Germain AA, Busby K, Urquia ML. Marital status, immigration, and reproductive health among adolescent mothers in Canada, 1990-2018: A population-based, observational study. Prev Med 2022; 164:107315. [PMID: 36273618 DOI: 10.1016/j.ypmed.2022.107315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
Immigrants to Canada increasingly come from regions where child marriage (<18 years) is prevalent. We described the prevalence, demographic characteristics, and reproductive health correlates of marriage among births to Canadian-born and foreign-born adolescent mothers. Using Canadian birth registrations from 1990 to 2018, marriage prevalence, parental birth region, and parental age gap were examined by maternal birthplace (Canada and 12 world regions) among births to mothers <18 years. Adjusted odds ratios (AORs) of preterm birth (PTB), small for gestational age (SGA), and repeat birth were estimated for the joint associations of adolescent maternal age group (<18-year, 18-19-year, and 20-24-year), marriage, and nativity status (n = 1,904,200). Depending on maternal birthplace, marital births represented 2.6% to 81.8% of births to mothers <18 years. Marriage among mothers giving birth at <18 years was associated with higher proportions of parents from the same birthplace and larger parental age gaps. AORs of PTB tended to increase with lower maternal age. AORs of SGA were generally higher among births to foreign-born mothers. Marriage was associated with lower AORs of PTB and SGA among births to Canadian-born mothers and PTB among births to foreign-born mothers in the older adolescent age groups, but no association existed in the <18-year group. Marriage was positively associated with repeat birth in all adolescent age groups, with stronger associations in the <18-year group. The reproductive health correlates of marriage are similar between births to Canadian-born and foreign-born mothers <18 years but some differ between births to mothers <18 years and those to older adolescent mothers.
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Affiliation(s)
- Andrée-Anne Fafard St-Germain
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Karen Busby
- Faculty of Law, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Ahinkorah BO, Onayemi OM, Seidu AA, Awopegba OE, Ajayi AI. Association Between Girl-child Marriage and Intimate Partner Violence in Sub-Saharan Africa: Insights From a Multicountry Analysis of Demographic and Health Surveys. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP13560-NP13580. [PMID: 33832374 DOI: 10.1177/08862605211005139] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While considerable attention has been given to the health consequences of child marriage in Sub-Saharan Africa (SSA), limited studies exist on its impact on intimate partner violence (IPV) in the region. We address this gap by examining the link between child marriage and IPV. We tested our study hypothesis using demographic and health survey data of 28,206 young women aged 20-24 years from 16 SSA countries with recent surveys (2015-2019). Binary logistic regression models were used to examine the effect of child marriage on IPV. Child marriage prevalence ranged from 13.5% in Rwanda, in East Africa, to 77% in Chad, in Central Africa, while IPV ranged from 17.5% in Mozambique in Southern Africa to 42% in Uganda, in East Africa. Past year experience of IPV was higher among young women who married or begun cohabiting before the age of 18 (36.9%) than those who did at age 18 or more (32.5%). This result was consistent for all forms of violence: physical violence (22.7% vs 19.7%), emotional violence (25.3% vs 21.9%), and sexual violence (12% vs 10.4%). After controlling for covariates, we found that young women in SSA who married before 18 years were more likely to experience IPV than those who married as adults (AOR: 1.20; 95% CI [1.12, 1.29]). Significant heterogeneity was observed in the country-level results, with a higher likelihood of IPV found in 14 of the 16 countries and lower in Angola and Chad. Child marriage is associated with a higher likelihood of IPV in most SSA countries, suggesting that ending child marriage will result in a substantial reduction in IPV. There is a need to institute policies to support and protect women who marry as children from abusive relationships in SSA.
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Affiliation(s)
| | | | - Abdul-Aziz Seidu
- University of Cape Coast, Ghana
- James Cook University, Townsville, Queensland, Australia
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Doke PP, Gothankar JS, Chutke AP, Palkar SH, Patil AV, Pore PD, Bhuyan KK, Karnataki MV, Deshpande AV, Shrotri AN, Narula APS. Prevalence of preconception risk factors for adverse pregnancy outcome among women from tribal and non-tribal blocks in Nashik district, India: a cross-sectional study. Reprod Health 2022; 19:166. [PMID: 35897076 PMCID: PMC9327168 DOI: 10.1186/s12978-022-01473-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although critical, the preconception phase in women's lives is comparatively ignored. The presence of some risk factors during this phase adversely affects the wellbeing of the woman and the pregnancy outcome. The study objectives were to measure the prevalence of various known risk factors for adverse pregnancy outcome in the preconception period of women and their comparison between blocks. METHODS This was a community-based cross-sectional study in two tribal and two non-tribal blocks each in Nasik district, Maharashtra, India. The study included married women desiring to conceive within 1 year. Trained Accredited Social Health Activists (field level health worker) collected information from women using a validated interview schedule through house-to-house visits and obtained women's anthropometric measurements in a standard manner. The study assessed the presence of 12 documented risk factors. RESULTS The study enlisted 7875 women desiring pregnancy soon. The mean age of women was 23.19 (± 3.71) years, and 16% of them were adolescents. Women's illiteracy was higher in tribal areas than non-tribal (p < 0.001). About two-thirds of women have at least one risk factor, and 40.0% have a single risk factor. The most common risk factor observed was no formal education (44.35%). The prevalence of selected risk factors was significantly higher among women from tribal areas. The mean BMI of women was 19.73 (± 3.51), and a higher proportion (40.5%) of women from tribal areas had BMI < 18.5. Despite being of high parity status (≥ 4), about 7.7% of women from the tribal area and 3% from non-tribal desired pregnancy. Tobacco and alcohol consumption was higher among tribal women. The majority of women consumed meals with family members or husbands. Protein and calorie intake of about 1.4% of women was less than 50% of the recommended daily allowance; however, most of them perceived to have abundant food. CONCLUSIONS Health risks, namely younger age, illiteracy, high parity, consumption of tobacco, low protein, and calorie intake, were quite prevalent, and the risks were significantly more among women from tribal areas. "Continuum of care" must comprise preconception care inclusive of Behavioral Change Communication, particularly for easily modifiable risk factors and specially for tribal women.
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Affiliation(s)
- Prakash Prabhakarrao Doke
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, 411043, India
| | - Jayashree Sachin Gothankar
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, 411043, India.
| | - Amruta Paresh Chutke
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, 411043, India
| | - Sonali Hemant Palkar
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, 411043, India
| | - Archana Vasantrao Patil
- State Family Welfare Bureau, Department of Public Health, Government of Maharashtra, Pune, 411001, India
| | - Prasad Dnyandeo Pore
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, 411043, India
| | | | | | | | - Aparna Nishikant Shrotri
- State Family Welfare Bureau, Department of Public Health, Government of Maharashtra, Pune, 411001, India
| | - Arvinder Pal Singh Narula
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, 411043, India
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Dadras O, Khampaya T, Nakayama T. Child Marriage, Reproductive Outcomes, and Service Utilization among Young Afghan Women: Findings from a Nationally Representative Survey in Afghanistan. Stud Fam Plann 2022; 53:417-431. [PMID: 35736515 DOI: 10.1111/sifp.12207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study explored the prevalence of child marriage and its association with reproductive outcomes and service utilization among young women in Afghanistan. We conducted a secondary analysis of data from the 2015 Afghanistan Demographic and Health Survey (DHS), focusing on women aged 20-24 years old based on the United Nations' recommendation on child marriage study. Multivariate logistic models examined the association between child marriage, reproductive outcomes, and service utilization. An estimated 52% of the Afghan women aged 20-24 married at ages less than 18 years. Poverty and illiteracy were associated with the higher likelihood of early marriage. There was a significant negative relationship between child marriage and history of rapid repeat childbirth, delivery by skilled personnel, and institutional delivery. In both adjusted and unadjusted models, women married at age ≤14 were more likely to experience terminated or unintended pregnancy, inadequate ANC, unmet need for family planning, and fistula; while, for those married at age 15-17 years, only terminated or unintended pregnancy remained significant. Strict international law enforcement and advocacy are needed in the current situation of Afghanistan to increase young women's education, promote their civil rights, and improve their autonomy and role in decision-making concerning their fertility preferences and reproductive health.
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Affiliation(s)
- Omid Dadras
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Nakhon Si Thammarat, Thailand.,Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Iran
| | - Tanaporn Khampaya
- School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University, Japan
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Wells JCK. An Evolutionary Model of “Sexual Conflict” Over Women's Age at Marriage: Implications for Child Mortality and Undernutrition. Front Public Health 2022; 10:653433. [PMID: 35784199 PMCID: PMC9247288 DOI: 10.3389/fpubh.2022.653433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEarly women's marriage is associated with adverse outcomes for mothers and their offspring, including reduced human capital and increased child undernutrition and mortality. Despite preventive efforts, it remains common in many populations and is often favored by cultural norms. A key question is why it remains common, given such penalties. Using an evolutionary perspective, a simple mathematical model was developed to explore women's optimal marriage age under different circumstances, if the sole aim were to maximize maternal or paternal lifetime reproductive fitness (surviving offspring).MethodsThe model was based on several assumptions, supported by empirical evidence, regarding relationships between women's marital age and parental and offspring outcomes. It assumes that later marriage promotes women's autonomy, enhancing control over fertility and childcare, but increases paternity uncertainty. Given these assumptions, optimal marriage ages for maximizing maternal and paternal fitness were calculated. The basic model was then used to simulate environmental changes or public health interventions, including shifts in child mortality, suppression of women's autonomy, or promoting women's contraception or education.ResultsIn the basic model, paternal fitness is maximized at lower women's marriage age than is maternal fitness, with the paternal optimum worsening child undernutrition and mortality. A family planning intervention delays marriage age and reduces child mortality and undernutrition, at a cost to paternal but not maternal fitness. Reductions in child mortality favor earlier marriage but increase child undernutrition, whereas ecological shocks that increase child mortality favor later marriage but reduce fitness of both parents. An education intervention favors later marriage and reduces child mortality and undernutrition, but at a cost to paternal fitness. Efforts to suppress maternal autonomy substantially increase fitness of both parents, but only if other members of the household provide compensatory childcare.ConclusionEarly women's marriage maximizes paternal fitness despite relatively high child mortality and undernutrition, by increasing fertility and reducing paternity uncertainty. This tension between the sexes over the optimal marriage age is sensitive to ecological stresses or interventions. Education interventions seem most likely to improve maternal and child outcomes, but may be resisted by males and their kin as they may reduce paternal fitness.
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Urquia ML, Batista RF, Cunha Cardoso V, Grandi C, Fafard St Germain AA. The perinatal epidemiology of child and adolescent marriage in Brazil, 2011–2018. SSM Popul Health 2022; 18:101093. [PMID: 35464613 PMCID: PMC9018448 DOI: 10.1016/j.ssmph.2022.101093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 10/28/2022] Open
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Bickham DS, Hunt EA, Rich M. Child Marriage or Statutory Rape? A Comparison of Law and Practice Across the United States. J Adolesc Health 2022; 70:S72-S77. [PMID: 35184836 PMCID: PMC9597557 DOI: 10.1016/j.jadohealth.2021.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE In many U.S. states, children can legally marry at an earlier age than they can legally consent to sex, leading to situations in which sex between spouses may be a criminal act. Some states exempt sex between married persons from their definition of statutory rape, which may create perverse incentives for child marriage. We estimated the number of child marriages that violated statutory rape laws across the United States since January 1, 2000. METHODS We created a longitudinal database of statutory rape laws in place from 2000 to 2020 in each state. Using data from marriage certificates filed in 44 states and Washington, DC, we compared the age of married spouses with the text of state-specific statutory rape laws in place at the time the marriages occurred. RESULTS Child marriages violated statutory rape laws in 14 states. The proportion of child marriages that violated statutory rape laws varied from 1% to over 50%. In 33 states, some or all statutory rape laws exempted sex between married couples from the definition of crimes. In these states, the proportion of child marriages that would have been crimes, without these exemptions, varied from less than 1% to over 80%. CONCLUSIONS Our results highlight the blurred legal and conceptual boundaries between child marriage and sexual violence. The simultaneous legality of child marriage and marital exemptions to statutory rape laws provide legal loopholes for sexual acts with children that would otherwise be considered crimes. Marital exemptions to statutory rape laws may also incentivize a substantial portion of child marriages.
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Fafard St-Germain AA, Kirby RS, Urquia ML. Reproductive health among married and unmarried mothers aged less than 18, 18-19, and 20-24 years in the United States, 2014-2019: A population-based cross-sectional study. PLoS Med 2022; 19:e1003929. [PMID: 35271581 PMCID: PMC8912259 DOI: 10.1371/journal.pmed.1003929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies in low- and middle-income regions suggest that child marriage (<18 years) is a risk factor for poor reproductive outcomes among women. However, in high-income-country contexts where childbearing before age 18 occurs predominantly outside marriage, it is unknown whether marriage is adversely associated with reproductive health among mothers below age 18. This study examined the joint associations of marriage and adolescent maternal age group (<18, 18-19, and 20-24 years) with reproductive, maternal, and infant health indicators in the United States. METHODS AND FINDINGS Birth registrations with US resident mothers aged ≤24 years with complete information on marital status were drawn from the 2014 to 2019 Natality Public Use Files (n = 5,669,824). Odds ratios for the interaction between marital status and maternal age group were estimated using multivariable logistic regression, adjusting for covariates such as maternal race/ethnicity and nativity status, federal program participation, and paternal age. Marriage prevalence was 3.6%, 13.2%, and 34.1% among births to mothers aged <18, 18-19, and 20-24 years, respectively. Age gradients in the adjusted odds ratios (AORs) were present for most indicators, and many gradients differed by marital status. Among births to mothers aged <18 years, marriage was associated with greater adjusted odds of prior pregnancy termination (AOR 1.64, 95% CI 1.52-1.77, p < 0.001), repeat birth (AOR 2.84, 95% CI 2.68-3.00, p < 0.001), maternal smoking (AOR 1.24, 95% CI 1.15-1.35, p < 0.001), and infant morbidity (AOR 1.07, 95% CI 1.01-1.14, p = 0.03), but weaker or reverse associations existed among births to older mothers. For all maternal age groups, marriage was associated with lower adjusted odds of late or no prenatal care initiation, sexually transmitted infection, and no breastfeeding at hospital discharge, but these beneficial associations were weaker among births to mothers aged <18 and 18-19 years. Limitations of the study include its cross-sectional nature and lack of information on marriage timing relative to prior pregnancy events. CONCLUSIONS Marriage among mothers below age 18 is associated with both adverse and favorable reproductive, maternal, and infant health indicators. Heterogeneity exists in the relationship between marriage and reproductive health across adolescent maternal age groups, suggesting girl child marriages must be examined separately from marriages at older ages.
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Affiliation(s)
- Andrée-Anne Fafard St-Germain
- Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Russell S. Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Marcelo L. Urquia
- Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Adedini SA, Abatan SM, Ogunsakin AD, Alex-Ojei CA, Babalola BI, Shittu SB, Odusina EK, Ntoimo LFC. Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries. PLoS One 2022; 17:e0262688. [PMID: 35025949 PMCID: PMC8758032 DOI: 10.1371/journal.pone.0262688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/02/2022] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20-24 years) who married before age 18 and those who married at age 18 or above. METHOD Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20-24 (n = 33,630). RESULTS Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57-0.67, p<0.001), and women who married at ages 15-17 (OR: 0.81, CI: 0.75-0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics. CONCLUSION Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.
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Affiliation(s)
- Sunday A. Adedini
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
- Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa
- * E-mail:
| | - Sunday Matthew Abatan
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Adesoji Dunsin Ogunsakin
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Christiana Alake Alex-Ojei
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Blessing Iretioluwa Babalola
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Sarafa Babatunde Shittu
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Emmanuel Kolawole Odusina
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Lorretta Favour C. Ntoimo
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
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Kamal SMM, Ulas E. Child marriage and its association with Maternal Health Care Services utilisation among women aged 20-29: a multi-country study in the South Asia region. J OBSTET GYNAECOL 2022; 42:1186-1191. [PMID: 35164647 DOI: 10.1080/01443615.2022.2031929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite pervasiveness of child marriage in South Asian countries, its association with the usage of Maternal Health Care Services (MHCS) is poorly explored. In this study, we examined the impact of child marriage on MHCS utilisation among the prime reproductive aged women of five South Asian countries Afghanistan, Bangladesh, India, Nepal and Pakistan. Data for this study are extracted from the most recent Demographic and Health Surveys. The effect of child marriage on the use of MHCS was assessed by the multivariate logistic regression analysis. Findings reveal that in the South Asian region, the prevalence of child marriage is more common in Bangladesh, followed by Afghanistan, Nepal, India and Pakistan. Child marriage significantly (p< .01) deters the usage of MHCS - at least once antenatal care (ANC) visit, at least four ANC visit, Institutional delivery and seeking assistance from skilled birth assistance (SBA), though the effect size was somewhat different across the countries. Findings stipulate to remain girls in schooling more and the marriage acts of the countries should be enacted properly to diminish child marriage not only for increasing MHCS use, also for individual wellbeing and overall development of each country.Impact StatementWhat is already known on this subject? Child marriage in South Asian countries is commonplace despite substantial improvements of socioeconomic status. Although child marriage have many adverse reproductive and health outcomes, empirical evidence and systematic studies, particularly the association of child marriage with the usage of Maternal Health Care Services (MHCS) in the South Asian women are few.What do the results of this study add? Findings of this study affirm that prevalence of child marriage in South Asian region is still common. Although every country has set out minimum age at first marriage by acts, the acts are poorly followed, which adversely impacts the usage of MHCS among married women.What are the implications of these findings for clinical practice and/or future research? The study findings provide important insights of the consequence of child marriage on the skilled MHCS utilisation. The marriage acts of the countries should be enacted properly to restrict child marriage not only for increasing MHCS, also for individual wellbeing and overall development of each country. Study has important implications for planners, organisation managers and policy makers.
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Affiliation(s)
| | - Efehan Ulas
- Department of Statistics, Cankiri Karatekin University, Cankiri, Turkey
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Fan S, Koski A. The health consequences of child marriage: a systematic review of the evidence. BMC Public Health 2022; 22:309. [PMID: 35164724 PMCID: PMC8845223 DOI: 10.1186/s12889-022-12707-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/31/2022] [Indexed: 01/07/2023] Open
Abstract
Background Child marriage, defined as marriage before 18 years of age, is a violation of human rights and a marker of gender inequality. Growing attention to this issue on the global development agenda also reflects concerns that it may negatively impact health. We conducted a systematic review to synthesize existing research on the consequences of child marriage on health and to assess the risk of bias in this body of literature. Methods and findings We searched databases focused on biomedicine and global health for studies that estimated the effect of marrying before the age of 18 on any physical or mental health outcome or health behaviour. We identified 58 eligible articles, nearly all of which relied on cross-sectional data sources from sub-Saharan Africa or South Asia. The most studied health outcomes were indicators of fertility and fertility control, maternal health care, and intimate partner violence. All studies were at serious to critical risk of bias. Research consistently found that women who marry before the age of 18 begin having children at earlier ages and give birth to a larger number of children when compared to those who marry at 18 or later, but whether these outcomes were desired was not considered. Across studies, women who married as children were also consistently less likely to give birth in health care facilities or with assistance from skilled providers. Studies also uniformly concluded that child marriage increases the likelihood of experiencing physical violence from an intimate partner. However, research in many other domains, including use of contraception, unwanted pregnancy, and sexual violence came to divergent conclusions and challenge some common narratives regarding child marriage. Conclusions There are many reasons to be concerned about child marriage. However, evidence that child marriage causes the health outcomes described in this review is severely limited. There is more heterogeneity in the results of these studies than is often recognized. For these reasons, greater caution is warranted when discussing the potential impact of child marriage on health. We provide suggestions for avoiding common biases and improving the strength of the evidence on this subject. Trial registration The protocol of this systematic review was
registered with PROSPERO (CRD42020182652) in May 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12707-x.
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Affiliation(s)
- Suiqiong Fan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada
| | - Alissa Koski
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada. .,Institute for Health and Social Policy, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada.
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Hossain MM, Abdulla F, Banik R, Yeasmin S, Rahman A. Child marriage and its association with morbidity and mortality of under-5 years old children in Bangladesh. PLoS One 2022; 17:e0262927. [PMID: 35139075 PMCID: PMC8827428 DOI: 10.1371/journal.pone.0262927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Child marriage is a significant social and health concern in many low- and middle-income countries (LMICs). This harmful practice violates children's rights and continues to be widespread across developing nations like Bangladesh. This study investigated the mortality trend among Bangladeshi children and the impact of child marriage on under-5 children morbidity and mortality in Bangladesh. METHODS AND MATERIALS A sample of 8,321 children under-5 years old was analyzed using bivariate and multivariate statistical techniques collected from the recent 2017-18 BDHS data. Chi-square test and logistic regression (unadjusted and adjusted) were used to determine the influence of covariates on the target variable. RESULTS Results revealed that child mortality was significantly higher among children whose mothers married at an early age than their counterparts. Although the general trend in the prevalence of different childhood mortality in Bangladesh was declining gradually from 1993 to 2018, it was still high in 2018. Also, marriage after 18 years lessens likelihood of diarrhea (adjusted OR = 0.93; 95% CI: 0.76-1.16) and cough (adjusted OR = 0.91; 95% CI: 0.78-1.17) among children. Furthermore, findings reveal that likelihood of different child mortality is higher among early married women. CONCLUSION Immediate intervention through rigorous enforcement of policies and different programs to raise the age at marriage and by lessening socioeconomic disparities can combat the prevalence of high morbidity and mortality of under-5 years old children. Findings from this study will be helpful to accelerate strategies for achieving the Sustainable Development Goals (SDGs) related to child and maternal health by 2030.
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Affiliation(s)
| | - Faruq Abdulla
- Department of Applied Health and Nutrition, RTM Al-Kabir Technical University, Sylhet, Bangladesh
| | - Rajon Banik
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | | | - Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, Australia
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Abstract
Child marriage, which is seen as both a global public health and social problem, is defined as marriage before the age of 18 years. Gender inequality, migration and wars, economic problems, lack of education, and non-deterrent laws are the main causes of child marriage. Child marriage in our country, and other places where child marriage is still commonplace, is a breach of the widely recognized human rights of the child. Prevention of this breach requires effective and target-oriented counter-measures. At the same time, to achieve sustainable change, problems should be analyzed and solutions should be provided with programmed and multi-layered components. It should not be forgotten that “the child is not a bride, the place for the child is in school and the playground.”
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Affiliation(s)
- Hüseyin Dağ
- Department of Pediatric Basic Sciences, Istanbul University, Institute of Child Health, Adolesance Health, Istanbul, Turkey;Department of Pediatrics, University of Health Sciences, Istanbul Prof.Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Aylin Yetim
- Department of Pediatric Basic Sciences, Istanbul University, Institute of Child Health, Adolesance Health, Istanbul, Turkey
| | - Özlem Ketenci Altıkardeşler
- Department of Pediatric Basic Sciences, Istanbul University, Institute of Child Health, Adolesance Health, Istanbul, Turkey
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Abstract
Child marriage, defined as marriage before 18 years of age, has harmful consequences for health and development and is an indicator of gender inequality. We used publicly available data from the 2000 and 2010 censuses to estimate the national and provincial-level prevalence of child marriage across mainland China. Between 2000 and 2010, the prevalence of child marriage rose from 2.41 percent to 2.85 percent among women and from 0.54 percent to 0.77 percent among men. The 2010 estimates are equivalent to roughly 1.8 million women and 0.5 million men. Child marriage was more common in western provinces among both girls and boys. Provincial prevalence estimates ranged from 0.44 percent in Beijing to 12.94 percent in Qinghai among girls. Among boys, estimates ranged from 0.13 percent in Beijing to 5.03 percent in Tibet. The gender gap widened across much of the country between censuses. Our results indicate that child marriage continues across mainland China despite laws that ostensibly prohibit the practice. They also draw attention to the global nature of child marriage as a threat to gender equality.
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Affiliation(s)
- Suiqiong Fan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Yue Qian
- Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Alissa Koski
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Institute for Health and Social Policy, McGill University, Montreal, Canada
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Barral R, Kelley MA, Harrison ME, Svetaz MV, Efevbera Y, Bhave S, Kanbur N. Dismantling Inequities in Adolescent and Young Adult Health through a Sexual and Reproductive Health Justice Approach. Semin Reprod Med 2022; 40:131-145. [PMID: 35052004 DOI: 10.1055/s-0042-1742347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This article provides an overview of the social determinants of adolescents and young adults' (AYAs') sexual and reproductive health (SRH), from a global health perspective. The status of AYAs' SRH constitutes leading health indicators across nations and globally, and reveals the well-being of this population. Throughout the article, AYAs' SRH is approached from a health equity perspective, which includes SRH health rights and reproductive justice. Using this health equity lens, salient topics are presented: sexual abuse/assault among AYAs; immigrant and refugee populations; child, early, and forced marriage; human trafficking; and female genital mutilation. The article also discusses access to SRH services and comprehensive education. Practical implications and resources are offered for healthcare providers for their daily encounters with AYAs, as well as for community, institutional level, and advocacy action. Healthcare providers are well positioned to advance AYAs SRH through mitigating inequities and in so doing, they are assuring the health of the population and future generations.
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Affiliation(s)
- Romina Barral
- Division of Adolescent Medicine, Children's Mercy Kansas City, Kansas City, Missouri.,University of Missouri Kansas City School of Medicine, Kansas City, MO AND University of Kansas Medical Center, Kansas City, KS
| | - Michele A Kelley
- Emerita of Maternal and Child Health, School of Public Health, The University of Illinois at Chicago, Chicago, Illinois
| | - Megan E Harrison
- Division of Adolescent Health, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Maria Veronica Svetaz
- Hennepin Healthcare, Department of Family and Community Medicine, Leadership Education for Adolescent Health Program, University of Minnesota, Minneapolis, Minnesota
| | - Yvette Efevbera
- Gender-Based Violence and Child Marriage, Gender Equality, The Bill and Melinda Gates Foundation, Seattle, Washington
| | - Swati Bhave
- Adolescent Medicine, Dr D.Y. Patil Medical College, Pune, India
| | - Nuray Kanbur
- Division of Adolescent Health, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Elnakib S, Elsallab M, Wanis MA, Elshiwy S, Krishnapalan NP, Naja NA. Understanding the impacts of child marriage on the health and well-being of adolescent girls and young women residing in urban areas in Egypt. Reprod Health 2022; 19:8. [PMID: 35033114 PMCID: PMC8761304 DOI: 10.1186/s12978-021-01315-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Egypt has made progress in delaying age at marriage, but child marriage continues to be practiced in many places across the country. This study investigates the impacts of child marriage on the health and wellbeing of girls residing in urban Egypt using a multi-method approach. METHODS The quantitative component leveraged data from the 2014 Egypt Demographic and Health Survey and focused on (1) reproductive health, (2) maternal health and (3) social outcomes among a subsample of ever-married urban women ages 20-24 (N = 1041). Simple and multivariable logistic regressions were used to estimate prevalence odds ratios and 95% confidence intervals for associations between child marriage and the three sets of outcomes. The qualitative component drew from 11 focus groups, 23 in-depth interviews, and 13 key informant interviews conducted in three urban sites in Egypt. The data was thematically analyzed using a combination of inductive and deductive coding. RESULTS The prevalence of marriage under age 18 was 13.22%. Child marriage was significantly associated with ever use of contraception (Adjusted Odds Ratio (AOR) 2.95 95% CI 1.67-5.19), multiple births (AOR 12.93 95% CI 5.45-30.72), rapid repeat childbirth (AOR 2.20 95% CI 1.34-3.63), and pregnancy termination (AOR 1.89 95% CI 1.11-3.23). Many of these associations disappeared after adjusting for marriage duration. Girls married under age 18 had larger spousal age gaps (AOR 2.06; 95% CI 1.24-3.41) and higher odds of FGM (AOR 2.14; 95% CI 1.11-4.13). They were significantly more likely to report receiving no ANC care (AOR 0.39; 95% CI 0.19-0.80), and less likely to deliver through C-section (AOR: 0.53; 95% CI 0.34-0.83). Consequences emerging from the qualitative data centered around five themes: (1) Access to and use of sexual and reproductive health services; (2) exposure to FGM; (3) marriage and birth registration; (4) marital relations; and (5) relationship with in-laws. CONCLUSION Findings provide important insights into the practice of child marriage in urban areas in Egypt and illustrate a range of adverse consequences associated with the practice.
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Affiliation(s)
- Shatha Elnakib
- Johns Hopkins Bloomberg School of Public Health, Maryland, USA.
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Burgess RA, Jeffery M, Odero SA, Rose-Clarke K, Devakumar D. Overlooked and unaddressed: A narrative review of mental health consequences of child marriages. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000131. [PMID: 36962120 PMCID: PMC10021205 DOI: 10.1371/journal.pgph.0000131] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Child Marriage (before the age of 18) affects over 12 million young women globally, annually. Despite acknowledgement of the negative impacts of the practice on reproductive health, mental health consequences are largely overlooked. Given the ability for poor mental health to intensify other health and social challenges, understanding the mental health consequences linked to child marriage is vital. Our study is the first to examine how mental health is approached in current literature on child marriage. Our conceptual framework was informed by a rapid assessment of key issues in the field. Systematic searches of papers published between 2000-2020 were completed on four electronic databases with no language restrictions. Our protocol was registered on Prospero (CRD42019139685). Articles were assessed using PRISMA guidelines, and their quality assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 4,457 records identified, 21 papers meeting inclusion criteria were analysed using narrative synthesis. The final sample included 5 qualitative, 1 mixed-methods and 15 quantitative studies (14 cross-sectional and 1 longitudinal study) reporting on data from 12 countries, largely in the global south. Intimate partner violence, poverty, challenges in childbirth and isolation were identified as social factors linked to emotional distress by those married as children. Depression was the most reported mental disorder. Anxiety, phobias, psychological distress, substance misuse, negative well-being and anti-social personality disorder were reported less frequently. Findings highlight that while significant emotional distress and specific mental health conditions are linked to child marriage, gaps in our understanding remain. Future studies are needed to; clarify directionality in these relationships; understand the mental health needs of young men, LGBTQI communities and those in humanitarian settings. Given the well documented cyclical relationship between social determinants and mental health conditions, we outline a series of community-oriented interventions which blend psychological, social and structural support to promote mental health and wellbeing in the contexts of child marriage.
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Affiliation(s)
- Rochelle A. Burgess
- Institute for Global Health, University College London, London, United Kingdom
| | - Mairi Jeffery
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Kelly Rose-Clarke
- Department of Global and Social Medicine, Kings College London, London, United Kingdom
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Roy A, Chouhan P. Exploring the Socioeconomic Factors Associated with Girl Child Marriage and its Impact on Pregnancy Outcomes: A Study from Malda District of West Bengal. Indian J Community Med 2022; 47:8-11. [PMID: 35368482 PMCID: PMC8971856 DOI: 10.4103/ijcm.ijcm_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 10/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Child marriage is not a new phenomenon in India. The prevalence of child marriage remains high in many districts of West Bengal. Objectives: The present study aims to address socioeconomic factors associated with girl child marriage and its effect on selected pregnancy outcomes among women in the Malda district of West Bengal. Methods: The study is based on primary data, collected from the Manikchak CD block by adopting a random sample survey technique. The participants in the study consisted of 357 ever married women aged 15–49 years. Results: Multivariate analysis revealed that the prevalence of child marriage was substantially higher among women who had no formal education resided in the marginalized family. Similarly, educated parents were less likely to marry their daughter at an early age. Besides, the likelihood of miscarried or stillbirth, complications during pregnancy and delivery were significantly higher among those married <18 years than those married at 18 years or later. Conclusions: The findings of this study suggest preventing child marriage by increasing opportunities for girls' education and employment. The targeted approach should be made among rural and poor girls to reduce the vulnerability of child marriage.
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Affiliation(s)
- Avijit Roy
- Department of Geography, University of Gour Banga, Malda, West Bengal, India.,Department of Geography, Malda College, Malda, West Bengal, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
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Marphatia AA, Wells JCK, Reid AM, Yajnik CS. Biosocial life-course factors associated with women's early marriage in rural India: The prospective longitudinal Pune Maternal Nutrition Study. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 177:147-161. [PMID: 36787733 DOI: 10.1002/ajpa.24408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES By convention, women's early marriage is considered a sociocultural decision sensitive to factors acting during adolescence such as poverty, early menarche, and less education. Few studies have examined broader risk factors in the natal household prior to marriage. We investigated whether biosocial markers of parental investment through the daughters' life-course were associated with early marriage risk in rural India. We used an evolutionary perspective to interpret our findings. MATERIALS AND METHODS A prospective cohort recruited mothers at preconception. Children were followed from birth to age 21 years. Multivariable logistic regression models estimated odds ratios of marrying early (<19 years) associated first with wealth, age at menarche and education, and then with broader markers of maternal phenotype, natal household characteristics, and girls' growth trajectories. Models adjusted for confounders. RESULTS Of 305 girls, 71 (23%) had married early. Early married girls showed different patterns of growth compared to unmarried girls. Neither poverty nor early menarche predicted early marriage. Girls' non-completion of lower secondary school predicted early marriage, explaining 19% of the variance. Independent of girls' lower schooling, nuclear household, low paternal education, shorter gestation, and girls' poor infant weight gain were associated with marrying early, explaining in combination 35% of the variance. DISCUSSION Early marriage reflects "future discounting," where reduced parental investment in daughters' somatic and educational capital from early in her life favors an earlier transition to the life-course stage when reproduction can occur. Interventions initiated in adolescence may occur too late in the life-course to effectively delay women's marriage.
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Affiliation(s)
| | - Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alice M Reid
- Department of Geography, University of Cambridge, Cambridge, UK
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Adedini SA, Mobolaji JW, Adetutu OM, Abe JO, Oyinlola FF. Influence of child marriage on institutional delivery and high-risk births among young women in 31 sub-Saharan African countries. Women Health 2021; 62:85-93. [PMID: 34937521 DOI: 10.1080/03630242.2021.2020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
While child marriage persists in sub-Saharan Africa (SSA), little is known about its influence on institutional delivery/high-risk births (IDHRB). We analyzed pooled data on young women aged 15-24 (N = 113,588) from the most recent Demographic and Health Surveys of 31 SSA countries to examine the influence of child marriage on IDHRB. Binary logistic regression analysis was done to explore statistically significant relationships. Findings showed that unskilled delivery was significantly higher among women who married before age 15 (67.2%) and at ages 16-17 (48.2%) compared to those who married at age 18+ (30.2%). The prevalence of high-risk birth was higher among women who married before age 15 (97.2%) and at ages 16-17 (80.8%) compared to those who married at 18+ (48.4%). Inferential analysis showed that respondents who married before age 15 and at ages 16-17, respectively, had five-fold and two-fold higher odds of experiencing unskilled delivery compared to those who married at age 18 +. Odds of having high-risk births were significantly higher among child-brides compared to those who had first marriage as adults. This study concludes that policies/programs that would successfully delay first marriage among women must be pursued to reduce high-risk births and unskilled delivery in SSA.
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Affiliation(s)
- Sunday A Adedini
- Demography and Social Statistics Department, Faculty of Social Sciences, Federal University, Oye-Ekiti, Nigeria.,Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacob Wale Mobolaji
- Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olufemi Mayowa Adetutu
- Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - John Olugbenga Abe
- Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Funmilola F Oyinlola
- Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Raub A, Heymann J. Progress in National Policies Supporting the Sustainable Development Goals: Policies that Matter to Income and Its Impact on Health. Annu Rev Public Health 2021; 42:423-437. [PMID: 33348998 DOI: 10.1146/annurev-publhealth-040119-094151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
From education to working conditions, from income to discrimination, social determinants of health (SDH) shape the majority of health outcomes. Governments are often best positioned to address the major SDH on a population-wide basis. In 2015, governments around the world committed to improving all core SDH when all countries agreed to a set of goals that would improve education, work, income, and equal opportunity, among other areas, in the Sustainable Development Goals (SDGs). Using data from the WORLD Policy Analysis Center, this article highlights how quantitative policy measures can be used to hold governments accountable for their commitments to the SDGs and thus to improve the SDH. Three areas are examined in detail to illustrate this approach to monitoring policy change: ensuring an adequate income, enhancing equal opportunities at work by prohibiting discrimination and sexual harassment, and enabling children and youth to complete their education.
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Affiliation(s)
- Amy Raub
- WORLD Policy Analysis Center, University of California, Los Angeles, California 90095-1772, USA; ,
| | - Jody Heymann
- WORLD Policy Analysis Center, University of California, Los Angeles, California 90095-1772, USA; ,
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Marphatia AA, Saville NM, Manandhar DS, Cortina-Borja M, Wells JCK, Reid AM. Quantifying the association of natal household wealth with women's early marriage in Nepal. PeerJ 2021; 9:e12324. [PMID: 35003910 PMCID: PMC8684741 DOI: 10.7717/peerj.12324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Women's early marriage (<18 years) is a critical global health issue affecting 650 million women worldwide. It is associated with a range of adverse maternal physical and mental health outcomes, including early childbearing, child undernutrition and morbidity. Poverty is widely asserted to be the key risk factor driving early marriage. However, most studies do not measure wealth in the natal household, but instead, use marital household wealth as a proxy for natal wealth. Further research is required to understand the key drivers of early marriage. METHODS We investigated whether natal household poverty was associated with marrying early, independently of women's lower educational attainment and broader markers of household disadvantage. Data on natal household wealth (material asset score) for 2,432 women aged 18-39 years was used from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Different early marriage definitions (<15, <16, <17 and <18 years) were used because most of our population marries below the conventional 18-year cut-off. Logistic mixed-effects models were fitted to estimate the probabilities, derived from adjusted Odds Ratios, of (a) marrying at different early ages for the full sample and for the uneducated women, and (b) being uneducated in the first place. RESULTS Women married at median age 15 years (interquartile range 3), and only 18% married ≥18 years. Two-thirds of the women were entirely uneducated. We found that, rather than poverty, women's lower education was the primary factor associated with early marriage, regardless of how 'early' is defined. Neither poverty nor other markers of household disadvantage were associated with early marriage at any age in the uneducated women. However, poverty was associated with women being uneducated. CONCLUSION When assets are measured in the natal household in this population, there is no support for the conventional hypothesis that household poverty is associated with daughters' early marriage, but it is associated with not going to school. We propose that improving access to free education would both reduce early marriage and have broader benefits for maternal and child health and gender equality.
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Affiliation(s)
- Akanksha A. Marphatia
- Department of Geography, University of Cambridge, Cambridge, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Naomi M. Saville
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Jonathan C. K. Wells
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Alice M. Reid
- Department of Geography, University of Cambridge, Cambridge, United Kingdom
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Mejía-Guevara I, Cislaghi B, Darmstadt GL. Men's Attitude Towards Contraception and Sexuality, Women's Empowerment, and Demand Satisfied for Family Planning in India. FRONTIERS IN SOCIOLOGY 2021; 6:689980. [PMID: 34977228 PMCID: PMC8717326 DOI: 10.3389/fsoc.2021.689980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/15/2021] [Indexed: 05/02/2023]
Abstract
Whilst the prevalence of unmet need and contraceptive use remained unchanged for 10 years (between 2005-2015) in India, gender restrictive norms and power imbalances also have persisted, preventing married women from meeting their family planning desires. Data for this study are from the 2015-6 National Family Household Survey, which contains information on fertility preferences and family planning for women in reproductive age. As a proxy for men's attitudinal norms, we aggregated men's perceptions regarding contraception (contraception is women's business, women who use contraception may become promiscuous) and control over their wife (if his wife refuses to have sex, men have the right to deny financial support, have sex with another woman, or beat wife) at district level. Using a three-level random intercepts model, we assessed individual and contextual-level associations of men's attitudinal norms and met need for contraception among sexually active women (aged 15-49) with any demand for family planning, while adjusting for women's empowerment indicators [education, job status, and adult marriage] and individual demographic factors. Our results indicate that men's attitudinal norms are negatively associated with women's contraceptive use; for instance, a 1 standard deviation increase in the proportion of men who believe that contraception is women's business was associated with a 12% reduced likelihood of contraceptive use (OR = 0.88, 95% CI 0.82-0.95). Similar associations remained or were stronger after considering only modern methods, or when excluding female sterilization. Furthermore, our contextual effects analysis revealed that women's higher education or wealth did not improve contraceptive uptake in communities with strong attitudinal norms, but working women or women married as children were more likely to use contraception in those communities. Our results suggest that men's attitudinal norms may be dominating over women's empowerment regarding family planning choices among reproductive age women. However, employment appeared to play a strong protective role associated with women's contraceptive use. It is important for programs seeking to transform gender equality and empower women in making contraceptive choices to consider women's employment opportunities and to also address male attitudinal norms in the context of the ecosystem in which men and women coexist and interact.
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Affiliation(s)
- Iván Mejía-Guevara
- Stanford Aging and Ethnogeriatrics (SAGE) Research Center, Stanford University School of Medicine, Palo Alto, CA, United States
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Global Health, Makerere University, Kampala, Uganda
| | - Gary L. Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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Miller FA, Marphatia AA, Wells JC, Cortina-Borja M, Manandhar DS, Saville NM. Associations between early marriage and preterm delivery: Evidence from lowland Nepal. Am J Hum Biol 2021; 34:e23709. [PMID: 34862821 DOI: 10.1002/ajhb.23709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Preterm delivery (<37 weeks gestation) is the largest cause of child mortality worldwide. Marriage and pregnancy during adolescence have been associated with an increased risk of preterm delivery. We investigate independent associations of age at marriage and age at first pregnancy with preterm delivery in a cohort of women from rural lowland Nepal. METHODS We analyzed data from 17 974 women in the Low Birth Weight South Asia Trial. Logistic regression models tested associations of age at marriage and age at first pregnancy with preterm delivery, for primigravida (n = 6 243) and multigravida (n = 11 731) women. Models were adjusted for maternal education, maternal caste, and household asset score. RESULTS Ninety percent of participants had married at <18 years and 58% had their first pregnancy at <18 years. 20% of participants delivered preterm. Primigravida participants married at ≤14 years had higher odds of preterm delivery than those married ≥18 years, when adjusting for study design (adjusted odds ratio (aOR) 1.45, 95% CI: 1.15-1.83), confounders (aOR 1.28: 1.01-1.62) and confounders + age at pregnancy (aOR 1.29: 1.00-1.68). Associations were insignificant for multigravida women. No significant associations were observed between age at first pregnancy and preterm delivery. DISCUSSION In this population, early marriage, rather than pregnancy, is a risk factor for preterm delivery. We hypothesize that psychological stress, a driver of preterm delivery which is increased among those marrying young, rather than physiological immaturity, drives this association. Further research into the psychological consequences of child marriage in Nepal is needed.
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Affiliation(s)
- Faith A Miller
- Institute for Global Health (IGH), University College London (UCL), London, UK
| | - Akanksha A Marphatia
- Department of Geography, University of Cambridge, Cambridge, UK.,Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Jonathan C Wells
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | | | - Naomi M Saville
- Institute for Global Health (IGH), University College London (UCL), London, UK
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