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Marphatia A, Busert-Sebela L, Manandhar DS, Reid A, Cortina-Borja M, Saville N, Dahal M, Puri M, Wells JCK. Generational trends in the transition to womanhood in lowland rural Nepal: Changes in the meaning of early marriage. Am J Hum Biol 2024:e24088. [PMID: 38687248 DOI: 10.1002/ajhb.24088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE In South Asia, studies show secular trends toward slightly later women's marriage and first reproduction. However, data on related biological and social events, such as menarche and age of coresidence with husband, are often missing from these analyses. We assessed generational trends in key life events marking the transition to womanhood in rural lowland Nepal. METHODS We used data on 110 co-resident mother-in-law (MIL) and daughter-in-law (DIL) dyads. We used paired t-tests and chi-squared tests to evaluate generational trends in women's education, and mean age at menarche, marriage, cohabitation with husband, and first reproduction of MIL and DIL dyads. We examined norms held by MILs and DILs on a daughter's life opportunities. RESULTS On average, MIL was 29 years older than DIL (60 years vs. 31 years). Both groups experienced menarche at average age 13.8 years. MIL was married at average 12.4 years, before menarche, and cohabitated with husbands at average 14.8 years. DIL was simultaneously married and cohabitated with husbands after menarche, at average 15 years. DIL was marginally more educated than MIL but had their first child on average 0.8 years earlier (95% CI -1.4, -0.1). MIL and DIL held similar norms on daughters' education and marriage. CONCLUSION While social norms remain similar, the meaning of "early marriage" and use of menarche in marriage decisions has changed in rural lowland Nepal. Compared to DIL, MIL who was married earlier transitioned to womanhood more gradually. However, DIL was still married young, and had an accelerated trajectory to childbearing.
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Affiliation(s)
- A Marphatia
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Geography, University of Cambridge, Cambridge, UK
| | - L Busert-Sebela
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - D S Manandhar
- Mother and Infant Research Activities, Kathmandu, Nepal
| | - A Reid
- Department of Geography, University of Cambridge, Cambridge, UK
| | - M Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - N Saville
- Institute for Global Health, University College London, London, UK
| | - M Dahal
- Center for Research on Environment Health and Population Activities, Kathmandu, Nepal
| | - M Puri
- Center for Research on Environment Health and Population Activities, Kathmandu, Nepal
| | - J C K Wells
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
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Batyra E, Pesando LM. Increases in child marriage among the poorest in Mali: 'Reverse policies' or data quality issues? POPULATION STUDIES 2024; 78:93-111. [PMID: 37039104 DOI: 10.1080/00324728.2023.2181383] [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: 04/01/2022] [Accepted: 11/01/2022] [Indexed: 04/12/2023]
Abstract
Child marriage is associated with adverse outcomes related to women's well-being. Many countries have introduced laws banning this practice, and a number of studies have evaluated their impact. Scant research has focused on instances where countries have lowered the legal minimum age at marriage, even though such 'reverse policies' could result in stalled or uneven progress in eradicating child marriage. Using visualization techniques, regression analyses, and multiple robustness checks, we document changes in the prevalence of child marriage in Mali, where in 2011 the general minimum age at marriage of 18 was lowered to 16. Since 2011, the prevalence of child marriage has progressively increased among women with no education and women living in communities characterized by low local development. We reflect on the role that data collection processes may play in explaining some of these findings and stress how repealing existing provisions aiming to protect girls can have adverse consequences on the most vulnerable social strata.
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Affiliation(s)
- Ewa Batyra
- Centre for Demographic Studies (CED-CERCA)
- Max Planck Institute for Demographic Research
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Gutiérrez-García AI, Jiménez-Ruiz I, Siles-González J, Perpiñá-Galvañ J, Solano-Ruíz C. 'It's always difficult for women': an analysis of the life stories of sub-Saharan migrant women. J Biosoc Sci 2024; 56:376-390. [PMID: 37403587 DOI: 10.1017/s0021932023000135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
The aim of this study was to understand the perspectives of female residents of Spain from West Africa in terms of the factors that condition their lives. Pierre Bourdieu's theory and the model of intersectionality formed the framework we used to qualitatively analyse the life stories of these women, which was complemented with life lines. The results showed us that traditional practices such as female genital mutilation and forced marriage are part of the social habitus of this group and they relate to each other through the several types of violence that occurs throughout their lives. In addition, in reference to the African community, these women were no longer African, while in terms of the Spanish community, they did not seem Spanish. At a health, political, and social level, this knowledge can help us to understand this group and to create personalised targeted interventions for them.
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Affiliation(s)
| | - Ismael Jiménez-Ruiz
- Nursing Department, University of Murcia, Murcia, Spain
- Grupo de Investigación: Cuidados enfermeros avanzamos. Instituto Murciano de Investigación Biosanitaria Pascual Parrilla, Murcia, Spain
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Greene ME, Edmeades J, Siddiqi M. Scope, range and effectiveness of interventions to address social norms to prevent and delay child marriage and empower adolescent girls: a systematic review. BMJ Open 2024; 14:e071275. [PMID: 38191259 PMCID: PMC10806698 DOI: 10.1136/bmjopen-2022-071275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/20/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES Harmful gender and social norms prescribe divergent opportunities for girls and boys and drive child marriage. This systematic review examines the scope, range and effectiveness of interventions to change social norms and delay child marriage. DESIGN We systematically assess the contributions made by interventions that work to shift norms to prevent child marriage or to limit its harmful consequences. Our analysis classifies each study's quality in evaluation and implementation design regarding shifting norms. DATA SOURCES We conducted a search of electronic databases (PubMed, PsycINFO, Embase, CINAHL Plus, Popline, Web of Science and Cochrane Library) and grey literature (targeted hand-searches of 15 key organisations and Google Scholar). ELIGIBILITY CRITERIA Included interventions sought to change norms related to child marriage, were evaluated in experimental or quasi-experimental evaluations, collected data on age at marriage and norms/attitudes, and were published in English from January 2000 to September 2021. DATA EXTRACTION AND SYNTHESIS We used a standardised form to extract data from all eligible studies, and double-screened to validate coding and reporting. We classified the studies by low, medium and high quality for evaluation and risk of bias, and separately by the extent to which they addressed social norms. RESULTS Our assessment of the 12 eligible studies identified revealed little evidence of a systematic relationship between social norms related to marriage and changes in child marriage behaviours. We found stronger evidence of programme effect on child marriage outcomes than on social norms, though only a minority of studies found an effect for either. Studies that appeared effective in changing child marriage norms varied greatly in scale and extent of programming, and few attempted to identify the appropriate reference groups for measuring social norms. CONCLUSION The studies evaluated by our review provide only weak evidence on the impact of interventions on norms, and on the link between shifts in norms and marriage behaviour.
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Affiliation(s)
| | - Jeffrey Edmeades
- Avenir Health, Glastonbury, Connecticut, USA
- The Demographic and Health Surveys Program, Rockville, Maryland, USA
| | - Manahil Siddiqi
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
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Kidman R, Breton E, Mwera J, Zulu A, Behrman J, Kohler HP. Drivers of child marriages for girls: A prospective study in a low-income African setting. Glob Public Health 2024; 19:2335356. [PMID: 38584448 PMCID: PMC11025042 DOI: 10.1080/17441692.2024.2335356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Abstract
Child marriage has adverse consequences for young girls. Cross-sectional research has highlighted several potential drivers of early marriage. We analyse drivers of child marriage using longitudinal data from rural Malawi, where rates of child marriage are among the highest in the world despite being illegal. Estimates from survival models show that 26% of girls in our sample marry before age 18. Importantly, girls report high decision-making autonomy vis-à-vis the decision to marry. We use multivariate Cox proportional hazard models to explore the role of 1) poverty and economic factors, 2) opportunity or alternatives to marriage, 3) social norms and attitudes, 4) knowledge of the law and 5) girls' agency. Only three factors are consistently associated with child marriage. First, related to opportunities outside marriage, girls lagging in school at survey baseline have significantly higher rates of child marriage than their counterparts who were at or near grade level. Second, related to social norms, child marriage rates are significantly lower among respondents whose caregivers perceive that members of their community disapprove of child marriage. Third, knowledge of the law has a positive coefficient, a surprising result. These findings are aligned with the growing qualitative literature describing contexts where adolescent girls are more active agents in child marriages.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, Stony Brook University (State University of New York), Stony Brook, NY, USA
| | - Etienne Breton
- Department of Sociology, University of Pennsylvania, Philadelphia, USA
| | | | | | - Jere Behrman
- Departments of Economics and Sociology, Population Aging Research Center and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Hans-Peter Kohler
- Department of Sociology, Population Aging Research Center and Population Studies Center, University of Pennsylvania, Philadelphia, USA
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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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Cordova-Pozo KL, Anishettar SS, Kumar M, Chokhandre PK. Trends in child marriage, sexual violence, early sexual intercourse and the challenges for policy interventions to meet the sustainable development goals. Int J Equity Health 2023; 22:250. [PMID: 38053079 PMCID: PMC10696679 DOI: 10.1186/s12939-023-02060-9] [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: 08/18/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Child marriage remains a prevalent issue in low- and middle-income countries (LMIC) despite global declines. Girls are disproportionately affected, facing health risks, limited education, and restricted decision-making power. We aim to provide insights for child marriage prevalence across LMIC from 1990 to 2020, with a focus on sexual violence and early sexual intercourse for public health policy interventions. METHODS This study used World Bank datasets to assess progress in addressing child marriage in LMIC countries. Statistical analyses, including trend analysis and compound annual growth rate (CAGR), were conducted to evaluate indicators of first marriage, sexual violence, and sexual intercourse. Countries with sufficient data were categorized based on prevalence rates and trends, and detailed analysis focused on significant indicators. RESULTS While significant reductions were observed in the prevalence of child marriage before the age of 15 and 18 and early sexual intercourse in most countries, few countries show increasing trends, and others could not demonstrate statistical trends due to data limitations, such as scarcity of data for boys. Overall, many countries showed a decline in sexual violence and early sexual intercourse before the age of 15, but some exhibited increasing trends. For instance, Zambia and Senegal showed a decreasing trend of sexual violence, while Nigeria exhibited an increasing trend. Notably, Uganda, Cameroon, and Sierra Leone for women, and Namibia, Zambia, and Kenya for men, experienced substantial decline in early sexual intercourse. CONCLUSION There is a decline in child marriage, sexual violence, and early sexual intercourse in most countries independent from the income group. Only a few countries show slight increasing trends. The improvements confirm that policies that address education, employment, and deep-rooted gender inequality at the societal level seem to be effective and help reach the SDG. However, better data are needed to enhance the understanding of the development of child marriage in these countries to improve the effectiveness of policy intervention. Therefore, we recommend that policymakers not only include existing evidence that continues progress but also increase and improve the monitoring of relevant indicators.
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Affiliation(s)
| | | | - Manish Kumar
- Population Research Centre, JSS Institute of Economic Research Center, Dharwad, Karnataka, India
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Greene ME, Siddiqi M, Abularrage TF. Systematic scoping review of interventions to prevent and respond to child marriage across Africa: progress, gaps and priorities. BMJ Open 2023; 13:e061315. [PMID: 37130688 PMCID: PMC10163461 DOI: 10.1136/bmjopen-2022-061315] [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: 05/04/2023] Open
Abstract
OBJECTIVES Despite the high prevalence of child marriage in Africa, little is known about the current state of the evidence on interventions to prevent and respond to child marriage in the region. The objectives of this systematic scoping review are to describe the breadth of existing evidence on child marriage prevention and response interventions, analyze where these interventions have been implemented, and identify research gaps and priorities for moving forward. METHODS The inclusion criteria incorporated publications that: (1) focused on Africa, (2) described interventions to address child marriage, (3) were published 2000-2021 and (4) were published as peer-reviewed articles or reports in English. We searched seven databases (PubMed, PsychINFO, Embase, Cinahl Plus, Popline, Web of Science and Cochrane Library), hand-searched the websites of 15 organisations and used Google Scholar to identify research published in 2021. Two authors independently screened titles and abstracts followed by full-text reviews and data extraction for included studies. RESULTS Our analysis of the 132 intervention studies identified highlights important disparities by intervention type, sub-region, and intervention activities, focus populations and impact. The greatest number of intervention studies focused on Eastern Africa. Health and empowerment approaches were most represented, followed by education and laws and policies. Norms or livelihoods approaches were least represented. CONCLUSION Our review finds few high-quality impact evaluations, most of which assess cash transfer programmes. There is a need to strengthen evaluative evidence on other intervention approaches including empowerment and norms change interventions, in particular. Given the linguistic and cultural diversity of the continent, more country-specific studies and research published in languages other than English are needed, particularly in high-prevalence Middle African countries.
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Affiliation(s)
| | - Manahil Siddiqi
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Tara F Abularrage
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
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Ahinkorah BO, Aboagye RG, Okyere J, Seidu AA, Budu E, Yaya S. Correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa. BMC Pregnancy Childbirth 2023; 23:93. [PMID: 36737736 PMCID: PMC9896730 DOI: 10.1186/s12884-023-05361-7] [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: 09/01/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adolescent girls and young women are vulnerable populations who are at risk of several adverse sexual and reproductive health outcomes, including unintended pregnancies, sexually transmitted infections, unsafe abortions, and death from pregnancy-related complications. In this study, we examined the correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa (SSA). METHODS We extracted data from the most recent Demographic and Health Surveys (DHS) of 31 countries in SSA. Countries whose surveys were conducted from 2010 to 2020 were included in the study. A total of 108,572 adolescent girls and young women (15-24 years) were included in the study. We used a multilevel mixed-effect binary logistic regression analysis to examine the correlates of repeat pregnancies among adolescent girls and young women in SSA. RESULTS We found that adolescent girls and young women aged 20-24 [aOR = 2.36; 95%CI = 2.22, 2.51], those married [aOR = 7.52; 95%CI = 6.81, 8.30], living with a partner [aOR = 7.51; 95%CI = 6.87, 8.21], and those who had sexual intercourse before age 20 [aOR = 1.41; 95%CI = 1.33, 1.51] had higher odds of experiencing repeat pregnancies compared to those aged 15-19, those never in a union, those whose first sexual intercourse occurred at age 20 and above, respectively. Respondents exposed to listening to radio [aOR = 1.12; 95%CI = 1.06, 1.18] and those who justified intimate partner violence [aOR=1.13; 95%CI = 1.07, 1.19] had higher odds of experiencing repeat pregnancies compared to those who never listened to radio and those who did not justify intimate partner violence, respectively. Young women who had attained secondary or higher educational level [aOR = 0.83; 95%CI = 0.78, 0.90], those exposed to reading newspaper or magazine [aOR = 0.90; 95%CI = 0.82, 0.98], those residing in rural areas [aOR = 0.92; 95%CI = 0.86, 0.98], and those belonging to the richer [aOR = 0.87; 95%CI = 0.80, 0.95] and richest [aOR = 0.68; 95%CI = 0.61, 0.76] wealth quintile were less likely to experience repeat pregnancies. CONCLUSION The correlates of repeat pregnancies include age, age at first sexual intercourse, marital status, exposure to media, justification of intimate partner violence, wealth index, educational attainment, and place of residence. The findings underscore the need for governments and policymakers in SSA to implement policies that target the most at-risk groups: those with no formal education, the poor, and adolescent girls. Our findings also highlight the need to strengthen advocacy against the justification of intimate partner violence and intensify girl-child education.
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Affiliation(s)
- Bright Opoku Ahinkorah
- grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Richard Gyan Aboagye
- grid.449729.50000 0004 7707 5975Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Joshua Okyere
- grid.9829.a0000000109466120Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana ,grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- grid.511546.20000 0004 0424 5478Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana ,grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Eugene Budu
- grid.415489.50000 0004 0546 3805Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana
| | - Sanni Yaya
- grid.28046.380000 0001 2182 2255School of International Development and Global Studies, University of Ottawa, Ottawa, Canada ,grid.7445.20000 0001 2113 8111The George Institute for Global Health, Imperial College London, London, UK
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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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