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Bhowmik J, Apputhurai P, Williams J, Biswas RK. Investigating the role of women's education status and empowerment on accessing skilled birth attendance in Bangladesh: A structural equation modelling approach. Midwifery 2024; 138:104140. [PMID: 39142238 DOI: 10.1016/j.midw.2024.104140] [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: 01/25/2023] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND The objective of this study was to investigate the associations between women's education and access to skilled birth attendant (SBA) services mediated by factors of women's empowerment and sociodemographic characteristics using a path analysis through a structural equation (SEM) modelling approach. METHODS A sample of 4946 mothers from the most recent Bangladesh Demographic and Health Survey of 2017-18 was used in the SEM analysis. Accessing SBA service at childbirth was operationalized as utilizing SBA during last childbirth. After extracting the relevant variables and cleaning the original survey data, a subsample of 4,946 women were eligible for analysis in the current study. RESULTS The SEM model revealed strong evidence of direct, indirect, and mediating effects of both education and empowerment of women in accessing SBA services. Educated women have more autonomy in decision making and are less susceptible to family violence and consequently are more likely to access SBA services during childbirth (β = 0.094, p < 0.001). In addition, age at first marriage, media exposure, husband's education, healthcare accessibility, decision marking, and household wealth index mediated the relationship between education and SBA service use. CONCLUSION Bangladesh, a country that needs to improve several societal and health indices to achieve the Sustainable Development Goals, need to prioritize women's education to increase accessibility to maternal healthcare services. Health education and mass-media-driven awareness may be potential interventions for LMICs to increase SBA coverage.
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Affiliation(s)
- Jahar Bhowmik
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Australia.
| | - Pragalathan Apputhurai
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Australia
| | - Joanne Williams
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Raaj Kishore Biswas
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Khan MN, Khanam SJ, Khan MMA, Billah MA, Akter S. Exploring the impact of perceived early marriage on women's education and employment in Bangladesh through a mixed-methods study. Sci Rep 2024; 14:21683. [PMID: 39289504 PMCID: PMC11408660 DOI: 10.1038/s41598-024-73137-w] [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: 02/15/2024] [Accepted: 09/13/2024] [Indexed: 09/19/2024] Open
Abstract
Child marriage negatively affects women's socio-economic empowerment, particularly in education and employment. This study aimed to explore women' perspectives on the timing of their marriages, considering their educational and employment status at the time. It also sought to identify factors influencing early married women's perception of their marriages as timely. We analyzed both quantitative and qualitative data. The quantitative data included a sample of 5,596 women aged 15-24 from the 2017/18 Bangladesh Demographic and Health Survey. Additionally, we collected qualitative data through six in-depth interviews, two focus group discussions, and 13 key informant interviews. We used a multilevel mixed-effects Poisson regression model to examine the relationship between women's formal employment, education, and child marriage. Thematic analysis was employed for the qualitative data. Around 62% of the total women analysed reported their married occurred early with the mean age at marriage was 15.2 years. Approximately 55% of the total early married women believed their marriages occurred at the right time, especially among those who were employed at the time of their marriage. Among this subset, we also noticed a higher likelihood of discontinuing work and education following marriage. Qualitative findings revealed reasons behind this perception, such as escaping poverty, safety concerns, limited job prospects, and the impact of non-marital relationship and societal norms. While many early-married women perceived their marriage as timely, particularly those initially employed, this decision often coincides with a subsequent withdrawal from work and education. This underscores the pressing need for policies and programs aimed at educating women about the legal age for marriage and the negative consequences associated with early marriage while also equipping them with knowledge and resources for informed decision-making.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Namapara, Mymensingh, 2220, Bangladesh.
- Nossal Institute for Global Health, Melbourne School of Population and Global health, The University of Melbourne, Melbourne, 3010, Australia.
| | - Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Namapara, Mymensingh, 2220, Bangladesh
| | - Md Mostaured Ali Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Arif Billah
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shahinoor Akter
- La Trobe Rural Health School, John Richards Centre for Rural Ageing Research, La Trobe University, Melbourne, VIC, 3689, Australia
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Tebeje TM, Abebe M, Aragaw FM, Seifu BL, Mare KU, Shewarega ES, Sisay G, Seboka BT. A multiscale geographically weighted regression analysis of teenage pregnancy and associated factors among adolescents aged 15 to 19 in Ethiopia using the 2019 mini-demographic and health survey. PLoS One 2024; 19:e0310025. [PMID: 39240994 PMCID: PMC11379268 DOI: 10.1371/journal.pone.0310025] [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: 08/23/2023] [Accepted: 08/22/2024] [Indexed: 09/08/2024] Open
Abstract
BACKGROUND Teenage pregnancy remains one of the major reproductive health problems, especially in sub-Saharan African countries. It can lead to maternal and neonatal complications and social consequences. The proportion of teenage pregnancy differs across regions of Ethiopia. Thus, this study aimed to determine the spatial variation in determinants of teenage pregnancy among adolescents aged 15-19 years in Ethiopia using the 2019 Demographic and Health Survey (DHS). METHODS This study included a total weighted sample of 2165 teenage girls aged 15 to 19 years. A mixed-effect binary logistic regression model was employed to consider the hierarchical nature of the DHS data using STATA version 17. Adjusted odds ratios with 95% confidence intervals are reported, and a p-value less than 0.05 was used to identify significant predictors. The spatial analysis was conducted with ArcGIS version 10.7 and Python 3. To identify factors associated with the hotspots of teenage pregnancy, a multiscale geographically weighted regression (MGWR) was performed. Spatial regression models were compared using adjusted R2, the corrected Akaike information criterion (AICc), and the residual sum of squares (RSS). RESULTS The prevalence of teenage pregnancy among adolescents aged 15 to 19 years was 12.98% (95% CI: 11.6%, 14.5%). It was spatially clustered throughout the country with a significant Moran's I value. Significant hotspot areas were detected in central and southern Afar; northern, central, and western Gambela; northeastern and southern central Oromia; and the eastern Somali region. The MGWR analysis revealed that the significant predictors of spatial variations in teenage pregnancy were being illiterate and being married. Based on the multivariable multilevel analysis, age 17 (AOR = 3.54; 95% CI: 1.60, 7.81), 18 (AOR = 8.21; 95% CI: 3.96, 17.0), 19 (AOR = 15.0; 95% CI: 6.84, 32.9), being literate (AOR = 0.57; 95% CI: 0.35, 0.92), being married (AOR = 22.8; 95% CI: 14.1, 37.0), age of household head (AOR = 0.98; 95% CI: 0.98, 0.99) and residing in the Gambela region (AOR = 3.27; 95% CI: 1.21, 8.86) were significantly associated with teenage pregnancy among adolescents aged 15 to 19. CONCLUSION Teenage pregnancy is a public health problem in Ethiopia. Policymakers should prioritize addressing early marriage and improving teenage literacy rates, with a focus on the Gambela region and other hotspot areas. It is crucial to implement policies aimed at transforming the traditional practice of early marriage and to take measures to enhance literacy levels and promote awareness about sexual and reproductive health at the family and school levels. This will help ensure that young people have the opportunity to pursue education and make informed decisions about their reproductive health.
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Affiliation(s)
- Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Ever Siyoum Shewarega
- Department of Reproductive Health, School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Gizaw Sisay
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Binyam Tariku Seboka
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Ebabu KW, Workie DL, Woya AA, Sisha TA. Spatially-informed insights into early marriage and school dropout: An advanced bivariate binary multilevel model for understanding Ethiopia's context. Heliyon 2024; 10:e32005. [PMID: 38882301 PMCID: PMC11177129 DOI: 10.1016/j.heliyon.2024.e32005] [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: 07/31/2023] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
The phenomenon of school dropout, which entails the failure to meet the minimum educational requirements, and early marriage, which involves the marital union of girls prior to attaining 18 years of age, constitute crucial issues in Ethiopia. This research endeavor sought to identify the determinants of these two outcomes. A weighted sample of 3091 girls who had experienced early marriage and school dropout was drawn from the 2016 Ethiopian Demographic and Health Survey (EDHS) dataset and analyzed utilizing bivariate binary multilevel models featuring spatial effects. The prevalence rates of early marriage and school dropout were 62.9 % and 75.4 %, respectively. We observed non-uniform spatial distributions of early marriage and school dropout across Ethiopia. The odds ratio of the association between early marriage and school dropout was 1.39, indicating a significant interdependence of these two outcomes. The probability of early marriage and school dropout was estimated to be 1.63 and 1.18 times higher, respectively, for girls hailing from rural areas and 1.70 and 1.23 times higher, respectively, for those classified in the poorest wealth index, as compared to their counterparts. Therefore, stakeholders and policymakers must prioritize hotspots, socio-economic, and demographic factors to achieve a meaningful reduction in the incidence of early marriage and school dropout.
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Affiliation(s)
| | | | | | - Teshager Assefa Sisha
- Department of Statistics, Bahir Dar University, Ethiopia
- Department of Agricultural Economics, University of Kentucky, USA
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Pourtaheri A, Mahdizadeh M, Tehrani H, Jamali J, Peyman N. Socio-ecological factors of girl child marriage: a meta-synthesis of qualitative research. BMC Public Health 2024; 24:428. [PMID: 38341573 PMCID: PMC10858465 DOI: 10.1186/s12889-023-17626-z] [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: 07/18/2023] [Accepted: 12/31/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Child marriage of girls is one example of human rights violations, and is increasingly recognized as a key obstacle to global public health. Given the importance of a comprehensive understanding of the motivations for child marriage, this study aimed to identify socio-ecological factors contributing to gills child marriage. METHODS A comprehensive search was conducted of all English-language studies measuring causes of child marriage between 2000 and October 2022 in the Web of Science, PubMed, Scopus, PsycInfo, ProQuest, Poplin and Google Scholar databases. Girl child marriage is defined as a marriage under the age of 18. In this study, the CASP evaluation checklist was used to collect data. Two independent reviewers reviewed all articles. RESULTS A total of 34 eligible qualitative articles were included. The most salient causes of child marriage among girls include low skills and knowledge, internal and external beliefs and motivations, and physical advantages at the individual level. Family characteristics and structure contribute to child marriage at the interpersonal level, while environmental and economic factors play a role at the community level. Social factors and cultural norms, as well as the shortcomings and weaknesses of legislation, are also contributing factors at the society level. CONCLUSION The results showed that cultural beliefs supporting gender inequality and economic status were the most important causes of child marriage. These results can help policymakers and decision-makers implement strategies to reduce gender inequality to prevent child marriage.
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Affiliation(s)
- Asma Pourtaheri
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrsadat Mahdizadeh
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Tehrani
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jamshid Jamali
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nooshin Peyman
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Dessie AM, Anley DT, Zemene MA, Gebeyehu NA, Adella GA, Kassie GA, Mengstie MA, Seid MA, Abebe EC, Gesese MM, Tegegne KD, Anteneh RM, Solomon Y, Moges N, Bantie B, Feleke SF, Dejenie TA, Geremew H. Trend, determinants, and future prospect of child marriage in the Amhara region, Ethiopia: a multivariate decomposition analysis. Front Public Health 2023; 11:1132148. [PMID: 37780428 PMCID: PMC10537212 DOI: 10.3389/fpubh.2023.1132148] [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: 12/26/2022] [Accepted: 08/16/2023] [Indexed: 10/03/2023] Open
Abstract
Background Child marriage is a harmful traditional practice, which compromises children of their childhood and threatens their lives and health. In Ethiopia, 58% of women and 9% of men get married before the age of 18 years. Surprisingly, parents in the Amhara region make marriage promises of their children before they are even born, which will hinder the region from attaining the Sustainable Development Goal of ending child marriage. Thus, this study aimed to assess the trends, determinants, and future prospects of child marriage in the Amhara region of Ethiopia. Methods A repeated cross-sectional study was conducted using four consecutive nationally representative Ethiopian demographic and health surveys (2000-2016). A logit-based multivariate decomposition analysis for a non-linear response model was fitted to identify factors that contributed to the change in child marriage over time. Statistical significance was declared at a p-value of < 0.05. The child marriage practice in the Amhara region by the year 2030 was also predicted using different forecasting features of Excel. Results The trend of child marriage over the study period (2000-2016) decreased from 79.9% (76.7, 82.8) to 42.9% (39.1, 46.9), with an annual average reduction rate of 2.9%. Approximately 35.2% of the decline resulted from an increase in the proportion of women who attained secondary and above-secondary education over the two surveys. A decrease in the proportion of rural women and a change in the behavior of educated and media-exposed women also contributed significantly to the decline in child marriage. The prevalence of child marriage in the Amhara region by the year 2030 was also predicted to be 10.1% or 8.8%. Conclusion Though there has been a significant decline in child marriage in the Amhara region over the past 16 years, the proportion is still high, and the region is not going to eliminate it by 2030. Education, residence, and media exposure were all factors associated with the observed change in child marriage in this study. Therefore, additional efforts will be required if child marriage is to be eliminated by 2030, and investing more in education and media access will hasten the region's progress in this direction.
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Affiliation(s)
- Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Woliata Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Woliata Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Rahel Mulatie Anteneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yenealem Solomon
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Geremew
- College of Health Science, Oda Bultum University, Chiro, Ethiopia
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Zabak S, Varma A, Bansod S, Pohane MR. Exploring the Complex Landscape of Delayed Childbearing: Factors, History, and Long-Term Implications. Cureus 2023; 15:e46291. [PMID: 37915872 PMCID: PMC10616531 DOI: 10.7759/cureus.46291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
This review article delves into the intricate landscape of delayed childbearing, shedding light on the factors influencing individuals' decisions to postpone parenthood. In a world undergoing rapid social, economic, and technological transformations, the concept of when and why to become a parent has evolved significantly. We explore historical trends, societal norms, psychological dynamics, policy implications, and prospects surrounding delayed childbearing. This review underscores the diverse influences shaping this trend, from economic considerations and changing cultural perspectives to advancements in reproductive technologies and the complexities of work-life balance. By examining the emotional dimensions and long-term consequences, we comprehensively understand the implications for individuals, families, and societies. As we conclude, we emphasize the importance of addressing challenges and embracing opportunities to create a supportive environment for those navigating the complex decisions tied to delayed childbearing.
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Affiliation(s)
- Siddharth Zabak
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Varma
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Spandan Bansod
- Department of Obstetrics and Gynecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Meera R Pohane
- Medical Surgical Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Tiwari A, Datta BK, Haider MR, Jahan M. The role of child marriage and marital disruptions on hypertension in women - A nationally representative study from India. SSM Popul Health 2023; 22:101409. [PMID: 37132019 PMCID: PMC10149281 DOI: 10.1016/j.ssmph.2023.101409] [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: 11/17/2022] [Revised: 03/14/2023] [Accepted: 04/16/2023] [Indexed: 05/04/2023] Open
Abstract
Child marriage is associated with negative health trajectories among women in low- and middle-income countries (LMICs). Marital disruptions in LMICs are also associated with adverse socioeconomic and health outcomes in women. Yet, little is known about the compounded health effects of experiencing both child marriage and marital disruptions. Using nationally representative data from India among women aged 18-49 years, we examined the effects of marital age (i.e., marriage before or after 18 years) and martial disruptions (i.e., widowed/divorced/separated) on the odds of having hypertension. Findings suggest that together, marital disruptions and child marriage increase the risk of hypertension. Specifically, women married as children and who experienced marital disruptions were 1.2 (95% CI: 1.2-1.3) times more likely to have hypertension compared to women who married as adults and currently in marriage. Additionally, among women married as children, those who experienced martial disruptions had a higher risk (AOR = 1.1, 95% CI: 1.0-1.2) of hypertension compared to their currently married peers. These results suggest public health strategies must consider contextual effects of being widowed/divorced/separated among women who were married as children. Simultaneously, prevention initiatives should be strengthened to reduce the incidence of child marriage in LMICs and associated downstream health consequences.
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Affiliation(s)
- Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, 1120 15th Street, CJ 2300, Augusta, GA, 30912, USA
- Corresponding author.
| | - Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, 1120 15th Street, CJ 2300, Augusta, GA, 30912, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Wright Hall 301B 100 Foster Rd, Athens, GA, 30602, USA
| | - Murshed Jahan
- Langdale College of Business Administration, Valdosta State University, 1500 N. Patterson St, Valdosta, GA, 31698, USA
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Datta B, Pandey A, Tiwari A. Child Marriage and Problems Accessing Healthcare in Adulthood: Evidence from India. Healthcare (Basel) 2022; 10:1994. [PMID: 36292439 PMCID: PMC9601764 DOI: 10.3390/healthcare10101994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022] Open
Abstract
The association between child marriage and the access to or utilization of maternal and antenatal healthcare has been widely studied. However, little is known about child brides' access to healthcare for illnesses later in life. Using data on 496,283 married women aged 18 to 49 years from the India National Family and Health Survey 2015-2016, we developed an 11-point composite score (ranging from 0 to 10) outlining the extent of problems accessing healthcare, as follows: (i) no/little problem (score 0 to 2), (ii) some problems (score 3 to 6), and (iii) big problems (score 7 to 10). The differences between child brides and their peers married as adults were assessed by the relative risk ratios obtained from multinomial logistic regressions. The adjusted risk of having "some problems" and "big problems" accessing healthcare relative to "no/little problem" for child brides was found to be 1.22 (95% CI: 1.20-1.25) and 1.26 (95% CI: 1.22-1.29) times that of those married as adults, respectively. These findings highlight the disproportionate barriers to healthcare access faced by women married as children compared to women married as adults and the need for further research to inform policies regarding effective public health interventions to improve healthcare access.
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Affiliation(s)
- Biplab Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Ajay Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA 30912, USA
| | - Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
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Bahri N, Mirzaiinajmabadi K, Esmaeily H, Latifnejad Roudsari R. Women's Empowerment Status in Menopausal Transition: A Cross-sectional Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2022; 10:279-289. [PMID: 36274663 PMCID: PMC9579448 DOI: 10.30476/ijcbnm.2022.94547.2003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Women's empowerment status in menopausal transition is of great importance due to the increasing trend of life expectancy and population aging. This study was conducted to evaluate the empowerment status of women during the menopausal transition in Gonabad, Iran. METHODS This cross-sectional study was conducted in Gonabad city in Northeast of Iran from April 2017 to March 2018. Cluster sampling was used for selecting 680 women who were in the menopausal transition. Demographic questionnaire and Women's Empowerment Status Questionnaire - a researcher-made questionnaire- was used for data collection. Pearson's correlation coefficient, one-way ANOVA, and linear regression were used to analyze the data using SPSS version 16; A p-value less than 0.05 was considered as significant. RESULTS The majority of the participants (510; 76.10%) had a high empowerment level. A high empowerment status in the family, economic, social, and health domains was observed in 499 (74.50%), 534 (79.70%), 523 (78.05%), and 493 (73.60%) participants, respectively. The majority of the participants had moderate empowerment status in political (427; 70.40%) and religious domains (464; 69.30%). There was a negative correlation between the total empowerment score and the participants' age (P<0.001), husband's age (P<0.001), and the number of children (P<0.001). There was a positive correlation between the total empowerment score and education (P=0.003) as well as age of marriage (P=0.03). CONCLUSION Overall empowerment status of women in menopausal transition in Gonabad -Iran was high. However, in political and religious domains, the status was moderate. We suggest that empowered women should be invited to share their experiences with other females. Development of social networks could provide the basis for sharing the experiences of these women and helps policy makers to develop community empowerment programs.
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Affiliation(s)
- Narjes Bahri
- Department of Midwifery, Faculty of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Khadigeh Mirzaiinajmabadi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Habibollah Esmaeily
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Science, Mashhad, Iran
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Factors Affecting Nonadherence to WHO’s Recommended Antenatal Care Visits among Women in Pastoral Community, Northeastern Ethiopia: A Community-Based Cross-Sectional Study. Nurs Res Pract 2022; 2022:6120107. [PMID: 36051824 PMCID: PMC9427308 DOI: 10.1155/2022/6120107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. More than half of the pregnant women in Ethiopia do not receive the recommended number of antenatal care visits. In the Afar region, where women have limited access to healthcare services due to pastoral livelihood, evidence on noncompliance to the adequate number of antenatal care visits is scarce. Therefore, this study was intended to examine the level of nonadherence to the recommended antenatal care visits and its associated factors in the pastoral community of Northeast Ethiopia. Methods. A community-based cross-sectional study was conducted from 04 February to 22 March 2020 among randomly selected 703 women who gave birth within 24 months preceding the survey in the Transform HDR districts of the Afar region. Data were collected using a pretested structured interviewer-administered questionnaire. Data were entered into Epi-data version 4.2 and finally exported to Stata version 16 for further analysis. Bivariable and multivariable binary logistic regression analyses were done to identify factors affecting the nonadherence to the recommended antenatal care visits. Odds ratio with the corresponding 95% confidence interval were computed and the statistical significance of the explanatory variables was declared at a
-value <0.05. Results. Nonadherence to the recommended antenatal care visits was 57.0% (95% CI: 53.3%–60.7%). Attending primary (AOR (95% CI): 0.39 (0.22–0.72)) and secondary education and above (AOR (95% CI): 0.25 (0.08–0.77)), being married at the age of 18 years or older (AOR (95% CI): 0.48 (0.36–0.71)), and attending antenatal care at a health center (AOR (95% CI): 0.46 (0.26–0.81)) were associated decreased odds of nonadherence to the recommend visits. Moreover, a higher likelihood of nonadherence was found among women from households not possessing communication media (AOR (95% CI): 1.85 (1.18–2.88)) and those who initiated antenatal care attendance during the second (AOR (95% CI): 5.23 (3.54–7.72)) and third trimesters (AOR (95% CI): 8.81 (1.88–41.20)). Conclusions. Nearly six in ten women do not receive the recommended antenatal care visits, consistent with the national prevalence. Women’s education, age at marriage, type of health facility, possession of mass media, and timing of antenatal care attendance were associated with nonadherence to the recommended antenatal care visits. Thus, improving women’s literacy, dissemination of information regarding antenatal care through mass media, and strengthening interventions targeted to end child marriage are important in scaling up the level of adherence. Moreover, supporting community-based health education through health extension programs is crucial in reaching women with limited access to mass media.
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Early Marriage in Adolescence and Risk of High Blood Pressure and High Blood Glucose in Adulthood: Evidence from India. WOMEN 2022. [DOI: 10.3390/women2030020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adolescence, the transition phase to adulthood, is a critical period for physical and psychological development. Disruptions during this period, such as getting married, could result in various adverse short- and long-term health outcomes. This study aimed to assess the differential risk of two common chronic conditions—high blood pressure and high blood glucose—in adult women (20–49 years) who were married during different stages of adolescence (10–19 years) compared to women who were married in their youth (20–24 years). Using the most recent nationally representative data from India, we separately assessed the odds in favor of having the two chronic conditions for women who were married during early (10–14 years), middle (15–17 years), and late (18–19 years) adolescence. We found that an earlier age at marriage during adolescence was associated with a higher risk of chronic conditions later in life. Women who were married during early adolescence were respectively 1.29 and 1.23 times more likely (p < 0.001) to have high blood pressure and high blood glucose compared to women who were married in their youth. These findings highlight the importance of preventing underage marriage among adolescent females to address the risk of downstream chronic health consequences as adults.
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Spousal age-gaps, partner preferences, and consequences for well-being in four Colombian communities. EVOL HUM BEHAV 2022. [DOI: 10.1016/j.evolhumbehav.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Tewahido D, Worku A, Tadesse AW, Gulema H, Berhane Y. Adolescent girls trapped in early marriage social norm in rural Ethiopia: A vignette-based qualitative exploration. PLoS One 2022; 17:e0263987. [PMID: 35176081 PMCID: PMC8853576 DOI: 10.1371/journal.pone.0263987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Early marriage is not uncommon in Ethiopia, particularly for adolescent girls in rural settings. Social norms are among the factors believed to perpetuate early marriage practices. This qualitative study explores social norms surrounding adolescent girls’ marriage practices in West Hararghe, Ethiopia.
Methods
This study used the qualitative inquiry method to explore social norms in rural Ethiopia. Focus group discussions were conducted with purposively sampled married and unmarried adolescent girls, adolescent boys, and parents. A total of 158 individuals participated in the study, comprising 95 adolescents and 63 parents. Data were collected using locally developed vignettes. A thematic framework analysis approach using the Social Norms Analysis Plot (SNAP) was employed to diagnose and understand social norms.
Results
Adolescent girls’ marriage was found to be mainly influenced by their peers who conform to prevailing social norms. Marrying one’s first suitor was considered an opportunity not to be missed and a symbol of good luck. Relatives, neighbors, and marriage brokers facilitate adolescent girls’ marriage in accordance with the local social norms. Girls usually accept the first marriage proposal regardless of their age, and they are highly expected to do so by their peers, parents, and influential others. Exceptions from the early marriage social norm include adolescent girls determined to continue their education and those having supportive teachers.
Conclusions
In this study context, social norms strongly encourage early marriage and are mainly perpetuated by peers of adolescent girls and influential adults. A strong determination to continue education on the part of girls, strong school performance, and supportive schoolteachers are important conditions for circumventing social norms on early marriage. As social norms evolve slowly, we recommend periodical assessment in order to develop locally appropriate interventions against early marriage.
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Affiliation(s)
- Dagmawit Tewahido
- Nutrition and Behavioral Sciences Department, Addis Continental Institute of Public Health, Addis Ababa, Ethopia
- * E-mail:
| | - Alemayehu Worku
- Epidemiology and Biostatistics Department, Addis Continental Institute of Public Health, Addis Ababa, Ethopia
| | - Amare W. Tadesse
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Hanna Gulema
- Global Health and Health Policy Department, Addis Continental Institute of Public Health, Addis Ababa, Ethopia
| | - Yemane Berhane
- Epidemiology and Biostatistics Department, Addis Continental Institute of Public Health, Addis Ababa, Ethopia
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Samad N, Das P, Dilshad S, Al Banna H, Rabbani G, Sodunke TE, Hardcastle TC, Haq A, Afroz KA, Ahmad R, Haque M. Women's empowerment and fertility preferences of married women: analysis of demographic and health survey'2016 in Timor-Leste. AIMS Public Health 2022; 9:237-261. [PMID: 35634022 PMCID: PMC9114782 DOI: 10.3934/publichealth.2022017] [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: 10/28/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 11/21/2022] Open
Abstract
A recently independent state, Timor-Leste, is progressing towards socioeconomic development, prioritizing women empowerment while its increased fertility rate (4.1) could hinder the growth due to an uncontrolled population. Currently, limited evidence shows that indicators of women's empowerment are associated with fertility preferences and rates. The objective of this study was to assess the association between women empowerment and fertility preferences of married women aged 15 to 49 years in Timor-Leste using nationally representative survey data. The study was conducted using the data of the latest Timor-Leste Demographic and Health Survey 2016. The study included 4040 rural residents and 1810 urban residents of Timor-Leste. Multinomial logistic regression has been performed to assess the strength of association between the exposures indicating women's empowerment and outcome (fertility preference). After adjusting the selected covariates, the findings showed that exposures that indicate women empowerment in DHS, namely, the employment status of women, house and land ownership, ownership of the mobile phone, and independent bank account status, contraceptive use, and the attitude of women towards negotiating sexual relations are significantly associated with fertility preferences. The study shows higher the level of education, the less likely were the women to want more children, and unemployed women were with a higher number of children. Our study also found that the attitude of violence of spouses significantly influenced women's reproductive choice. However, employment had no significant correlation with decision-making opportunities and contraceptive selection due to a lack of substantial data. Also, no meaningful data was available regarding decision-making and fertility preferences. Our findings suggest that women's empowerment governs decision-making in fertility preferences, causing a decline in the fertility rate.
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Affiliation(s)
- Nandeeta Samad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Pranta Das
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
| | - Segufta Dilshad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Hasan Al Banna
- Institute of Social Welfare and Research, University of Dhaka, Dhaka, Bangladesh
| | - Golam Rabbani
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Ahsanul Haq
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka-1205, Bangladesh
| | - Khandaker Anika Afroz
- Deputy Manager (Former), Monitoring, Learning, and Evaluation, CEP, BRAC, Bangladesh
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, Bangladesh
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sugai Besi, 57000 Kuala Lumpur, Malaysia
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Onen C, Ocal NU. The views of adult married women living in villages on early marriage and its relation with the perception of health. Niger J Clin Pract 2022; 25:1173-1179. [DOI: 10.4103/njcp.njcp_1930_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Datta BK, Tiwari A, Garner J. Child marriage and exposure to secondhand smoke among women of childbearing age: evidence from a nationally representative study in India. Women Health 2021; 61:1016-1026. [PMID: 34839806 DOI: 10.1080/03630242.2021.2007198] [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
Women in low-and-middle income countries (LMICs) are disproportionately exposed to secondhand smoke (SHS), particularly in the home environment. Girls married before the age of 18 are more likely to remain at home and may be at higher risk of SHS exposure. This paper investigates whether women who were married as child brides had a higher risk of SHS exposure than their peers who were married as adults in India, where both burden of smoking and child marriage are critical public health concerns. Data were obtained from the 2015-2016 wave of the nationally representative India National Family Health Survey and included 306,788 married women ages 18 to 35 years. We estimated bivariate and multivariate logistic regressions to obtain odds ratios in favor of SHS exposure. The prevalence of SHS exposure for those who were married as adults was 50.3% while that was 55.2% for those who were married before age 18. After controlling for sociodemographic characteristics, the adjusted odds of SHS exposure for those who were married as child were 1.06 (95% CI: 1.03, 1.09) times that of those who were married as adults. Findings of this study inform policies for coordinated efforts to eliminate child marriage and strengthen tobacco control.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, USA.,Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, USA
| | - Jamani Garner
- Department of Psychological Sciences, Augusta University, Augusta, Georgia, USA
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