Mediating risk through young women's marital arrangements and intimate relationships in low-income communities in urban India

A Mixed Methods Exploration of Young Women's Agency and Mental Health during COVID-19 in Low-Income Communities in Mumbai, India

INTRODUCTION

Adolescent girls and young women (AGYW) in India face additional health inequities compared to their male peers, as gender norms constrain agency for prevention and self-care. The onset of the COVID-19 pandemic and associated lockdowns deepened health inequities and often worsened mental health, but the impacts on agency are unclear. This exploratory sequential mixed methods paper examined mental health and COVID-19 elements that exacerbated or mitigated adverse consequences for AGYW in low-income communities in Mumbai.

METHODS

We conducted semi-structured interviews with AGYW (aged 15-25 years; N = 60) and adults (parents, healthcare providers, community-based organization representative; N = 30). We administered a structured survey to AGYW (N = 150) to assess health concerns, depression and anxiety symptoms (using the PHQ-8 and GAD-7 scales), and experiences during COVID-19. We analyzed qualitative data using the constant comparative approach in Atlas.ti, and quantitative data using R and SPSS.

RESULTS

Qualitative data revealed that AGYW faced stressors and had limited agency during lockdowns due to limited access to education, financial insecurity, and community violence. Quantitative data indicated that limited agency in the context of COVID-19 was significantly associated with depression and anxiety. Financial resources to address COVID-19 created new employment and leadership opportunities for AGYW to become COVID educators and preschool teachers; participation in these opportunities was associated with less anxiety.

DISCUSSION

Pandemic stress was difficult for low-income AGYW in Mumbai. Mitigating programs for COVID-19 control helped address acute needs and enable capabilities. Exploring similar themes among a broader population of youth can help design strategies and opportunities for young people in low-income communities during health emergencies.

Marriage practices, decision-making process and contraception use among young married men in rural Odisha, India

Research on sexual and reproductive health including contraception use has predominantly focussed on women's behaviour. Much less is known about men's behaviour. We investigated the links between marriage practices and decision-making about contraception use among young married men in rural Odisha. This cross-sectional study used a mixed methods design. Data were collected through household surveys and in-depth interviews. Study findings revealed that over half of men were ill prepared for marriage and lacked understanding about what it would entail. Familiarity and communication between spouses were higher in self-arranged marriages and this contributed considerably to contraception use, while negative attitudes and lack of access to contraceptive supply and counselling hindered it. Many young men shied away from seeking contraception services at community level since the majority of frontline health workers providing such services were female. Findings reinforce the need for health system change to actively engage and involve young married men in decision-making about contraception use as well as to introduce male frontline health workers who can reach out to young men on SRH issues.

Semi-arranged marriages and dowry ambivalence: Tensions in the changing landscape of marriage formation in South Asia

Marriage is a point of change in young people's lives, especially in parts of the world that place high value on it, such as in South Asian countries including Nepal. However, marriage practices are changing, with a move towards more love marriage; this is likely to have important implications on women's status and agency, household and couple dynamics, and mental and physical health. The aim of this paper is to describe how changing marriage formation patterns and traditional practices such as co-residence and dowry are intersecting and impacting relationships post-marriage. In-depth qualitative interviews took place with 20 intact triads of newly married women, their husbands and their mothers-in-law, in one district of Nepal in 2017. Many marriages remain arranged; however, couples often talk or meet before marriage and feel that they are able to build a foundation of love before marrying. Access to technology facilitates this practice, although some couples are reluctant to admit their communication, suggesting stigma about this practice. Husbands have growing ambivalence about dowry, leading to confusion and negatively impacting on relationships post-marriage. A clash of traditional and modern ideas and practices is occurring in Nepal, influencing newly married women's household status and relationship quality, and potentially impacting women's health.