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Puri MC, Maharjan DC, Dahal M, Raifman S, Diamond-Smith N. Intimate partner violence, food insecurity and COVID-19 among newly married women in Nawalparasi district of Nepal: a longitudinal study. Sex Reprod Health Matters 2023; 31:2181282. [PMID: 37017613 PMCID: PMC10078121 DOI: 10.1080/26410397.2023.2181282] [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] [Indexed: 04/06/2023] Open
Abstract
This paper examines factors associated with intimate partner violence (IPV) among newly married women in Nepal, and how IPV was affected by food insecurity and COVID-19. Given evidence that food insecurity is associated with IPV and COVID-19, we explored whether increased food insecurity during COVID-19 is associated with changes in IPV. We used data from a cohort study of 200 newly married women aged 18-25 years, interviewed five times over two years at 6-month intervals (02/2018-07/2020), including after COVID-19-associated lockdowns. Bivariate analysis and mixed-effects logistic regression models were used to examine the association between selected risk factors and recent IPV. IPV increased from 24.5% at baseline to 49.2% before COVID-19 and to 80.4% after COVID-19. After adjusting for covariates, we find that both COVID-19 (OR = 2.93, 95% CI 1.07-8.02) and food insecurity (OR = 7.12, 95% CI 4.04-12.56) are associated with increased odds of IPV, and IPV increased more for food-insecure women post COVID-19 (compared to non-food insecure), but this was not statistically significant (confidence interval 0.76-8.69, p-value = 0.131). Young, newly married women experience high rates of IPV that increase with time in marriage, and COVID-19 has exacerbated this, especially for food-insecure women in the present sample. Along with enforcement of laws against IPV, our results suggest that special attention needs to be paid to women during a crisis time like the current COVID-19 pandemic, especially those who experience other household stressors.
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Affiliation(s)
- Mahesh C. Puri
- Co- Director, Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Dev Chandra Maharjan
- Data Manager, Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Minakshi Dahal
- Research Associate, Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Sarah Raifman
- Project Director, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Nadia Diamond-Smith
- Associate Professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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Pradhan MR, Mondal S. Examining the influence of Mother-in-law on family planning use in South Asia: insights from Bangladesh, India, Nepal, and Pakistan. BMC Womens Health 2023; 23:418. [PMID: 37553598 PMCID: PMC10410985 DOI: 10.1186/s12905-023-02587-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Contraceptive use contributes to improved maternal and child health, education, empowerment of women, slow population growth, and economic development. The role of the family in influencing women's health and health-seeking behavior is undergoing significant changes, owing to higher education, media exposure, and numerous government initiatives, in addition to women's enhanced agency across South Asia. Against this backdrop, this study assesses the relationship between women's living arrangements and contraceptive methods used in selected south Asian countries (India, Pakistan, Nepal, and Bangladesh). METHODS Data of currently married women aged 15-49 from the recent round of Demographic and Health Survey (DHS) of four South Asian countries, i.e., Nepal (2016), Pakistan (2017-18), Bangladesh (2017-18), and India (2019-21) had been used. Bivariate and multinomial logistic regression was performed using Stata with a 5% significance level. RESULTS Living arrangement of women had a significant association with contraceptive use in South Asia. The Mother-in-law (MIL) influenced the contraceptive method used by the Daughter-in-law (DIL), albeit a country-specific method choice. Modern limiting methods were significantly higher among women living with MIL in India. The use of the modern spacing method was considerably high among women co-residing with husband and/or unmarried child(ren) and MIL in Nepal and India. In Bangladesh, women living with husband and other family member including MIL were more likely to use modern spacing methods.. Women co-residing with the MIL had a higher likelihood of using any traditional contraceptive method in India. CONCLUSIONS The study suggests family planning program to cover MIL for enhancing their understanding on the benefits of contraceptive use and modifying norms around fertility. Strengthening the interaction between the grassroots level health workers and the MIL, enhancing social network of DIL may help informed choice and enhance the use of modern spacing methods. Women's family planning demands met with modern contraception, and informed contraceptive choices, must also be achieved to reach the 2030 Agenda for Sustainable Development.
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Affiliation(s)
- Manas Ranjan Pradhan
- Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra 400088 India
| | - Sourav Mondal
- Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, Maharashtra 400088 India
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Marphatia AA, Busert-Sebela LK, Gram L, Cortina-Borja M, Reid AM, Manandhar DS, Wells JCK, Saville NM. Maternal mental health and economic autonomy in lowland rural Nepal: Do parents-in-law provide constraint or support? Evol Med Public Health 2023; 11:229-243. [PMID: 37475838 PMCID: PMC10355796 DOI: 10.1093/emph/eoad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/28/2023] [Indexed: 07/22/2023] Open
Abstract
Background and objectives In patrilocal societies, married women typically co-reside with their parents-in-law, who may act in their son's reproductive interests. These relationships may shape maternal mental health and autonomy. Few studies have examined these dynamics from an evolutionary perspective. Theoretically, marital kin may increase their fitness by increasing maternal investment or by reducing paternity uncertainty. We explored how co-residence with parents-in-law and husband is associated with maternal outcomes to evaluate whether marital kin provide support or constraint. Methodology We analysed data from 444 households in rural lowland Nepal. Maternal mental health was assessed by General Health Questionnaire. Logistic regression models investigated whether, relative to mothers living with both husband and parents-in-law, those co-resident with other combinations of relatives had poorer mental health and lower household economic autonomy (decision-making, bargaining power), adjusting for socio-economic confounders. Results Co-residence with husband only, or neither husband nor parents-in-law, was associated with higher odds of mothers reporting feeling worthless and losing sleep but also earning income and making household expenditure decisions. Husband co-residence was associated with overall maternal distress but also with less unpaid care work and greater decision-making responsibility. There were no differences in maternal outcomes for mothers living with parents-in-law only, relative to those living with both husbands and parents-in-law. Conclusions and implications Co-residence of parents-in-law and husbands was associated with contrasting patterns of maternal mental health and economic autonomy. We suggest that different marital kin place different economic demands on mothers, while restricting their autonomy in different ways as forms of 'mate-guarding'.
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Affiliation(s)
| | | | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Alice M Reid
- Department of Geography, University of Cambridge, Cambridge, UK
| | | | - Jonathan C K Wells
- Corresponding author. Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK. Tel: +44 020 7905 2104; E-mail:
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Mitchell A, Puri MC, Dahal M, Cornell A, Upadhyay UD, Diamond-Smith NG. Impact of Sumadhur intervention on fertility and family planning decision-making norms: a mixed methods study. Reprod Health 2023; 20:80. [PMID: 37231469 DOI: 10.1186/s12978-023-01619-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Mindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making. METHODS In 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired sample nonparametric tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically. RESULTS Sumadhur significantly impacted (p < .05) norms related to pregnancy spacing and timing, and sex preference of children, as well as knowledge about family planning benefits, pregnancy prevention methods, and abortion legality. Family planning intent also increased among newly married women. Qualitative findings revealed improved family dynamics and gender equity, and shed light on remaining challenges. CONCLUSIONS Entrenched social norms surrounding fertility and family planning contrasted with participants' personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.
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Affiliation(s)
- Ashley Mitchell
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
- Bixby Center for Global Reproductive Health, San Francisco, CA, USA.
| | - Mahesh C Puri
- Center for Research On Environment, Health and Population Activities, Kathmandu, Nepal
| | - Minakshi Dahal
- Center for Research On Environment, Health and Population Activities, Kathmandu, Nepal
| | | | - Ushma D Upadhyay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Nadia G Diamond-Smith
- Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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Sedlander E, Dahal M, Bingenheimer JB, Puri MC, Rimal RN, Granovsky R, Diamond-Smith NG. Adapting and Validating the G-NORM (Gender Norms Scale) in Nepal: An Examination of How Gender Norms Are Associated with Agency and Reproductive Health Outcomes. Stud Fam Plann 2023; 54:181-200. [PMID: 36715570 DOI: 10.1111/sifp.12231] [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] [Indexed: 01/31/2023]
Abstract
Research calls for the sexual and reproductive rights field to prioritize gender norms to ensure that women can act on their reproductive rights. However, there is a gap in accepted measures. We addressed this by including important theoretical components of gender norms: differentiating between descriptive and injunctive norms and adding a referent group. Our team originally developed and validated the G-NORM, a gender norms scale, in India. In this paper, we describe how we subsequently adapted and validated it in Nepal. We administered items to women of reproductive age, conducted exploratory and confirmatory factor analysis, and examined associations between the subscales and reproductive health outcomes. Like the original G-NORM, our factor analyses showed that descriptive norms and injunctive norms comprise two distinct scales which fit the data well and had Cronbach alphas of 0.92 and 0.89. More equitable descriptive gender norms were associated with higher decision-making scores, increased odds of intending to use family planning, disagreeing that it is wrong to use family planning, and older ideal age at marriage. Injunctive gender norms were only associated with disagreeing that it is wrong to use family planning. Findings offer an improved measure of gender norms in Nepal and provide evidence that gender norms are critical for agency and reproductive health outcomes.
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Affiliation(s)
- Erica Sedlander
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Minakshi Dahal
- Center for Research on Environment, Health & Population Activities, Kathmandu, Nepal
| | | | - Mahesh C Puri
- Center for Research on Environment, Health & Population Activities, Kathmandu, Nepal
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Granovsky
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nadia G Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Jacobson LE, Fuentes-Rivera E, Schiavon R, Darney BG. Association of maternal age 35 years and over and prenatal care utilization, preterm birth, and low birth weight, Mexico 2008-2019. Int J Gynaecol Obstet 2023. [PMID: 36728566 DOI: 10.1002/ijgo.14707] [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: 12/15/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate prenatal care utilization, low birth weight, and preterm birth among women aged 35 years and older in Mexico from 2008 to 2019. METHODS We conducted a historical cohort study of all singleton live births in Mexico from 2008 to 2019. Outcomes were inadequate prenatal care, preterm birth, and low birth weight. We compared outcomes among women aged 35-39, 40-44, and 45-49 years with births to women aged 20-34 years. We used logistic regression to account for individual, health system, and contextual confounders. RESULTS We included a total of 19 526 922 births; 2 325 725 (11.9%) were to women aged 35 years and older. Women aged 45-49 years had the lowest levels of education, were more likely to be uninsured, and came from highly marginalized municipalities while those aged 35-39 years had the highest levels of education and insurance and came from the least marginalized municipalities. The odds of inadequate prenatal care (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI] 1.09-1.15), preterm birth (aOR 2.05; 95% CI 1.97-2.13), and low birth weight (aOR 2.03; 95% CI 1.95-2.12) were highest for women aged 45-49 years, compared with women aged 20-34 years. The odds of adverse perinatal outcomes increased progressively with age, but the odds of inadequate prenatal care (aOR 0.77; 95% CI 0.76-0.77) were lowest for women aged 35-39 years, when compared with women aged 20-34 years. CONCLUSION Women who deliver at 35 years and over are a heterogeneous group in Mexico. Being 35 years old and older is associated with increases in preterm birth and low birth weight neonates. Women who give birth between 45 and 49 years may be especially vulnerable.
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Affiliation(s)
- Laura E Jacobson
- OHSU-PSU School of Public Health, Portland, Oregon, USA.,Oregon Health & Science University, Department of Obstetrics & Gynecology, Portland, Oregon, USA
| | | | | | - Blair G Darney
- OHSU-PSU School of Public Health, Portland, Oregon, USA.,Oregon Health & Science University, Department of Obstetrics & Gynecology, Portland, Oregon, USA.,Health Research Consortium (CISIDAT), Cuernavaca, Mexico.,Insituto Nacional de Salud Publica (INSP), Centro de Investigacion en Salud Poblacional (CISP), Cuernavaca, Mexico
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Frini O, Muller C. Revisiting fertility regulation and family ties in Tunisia. BMC Pregnancy Childbirth 2023; 23:88. [PMID: 36726068 PMCID: PMC9890736 DOI: 10.1186/s12884-023-05408-9] [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: 09/02/2022] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND We revisit fertility regulation in Tunisia by examining the role of the extended family. As marriage is the exclusive acknowledged childbearing context, we examine fertility analysis in Tunisia through the sequence: woman's marriage age, post-marriage delay in the first use of contraception, and past and current contraceptive use. We trace the family socio-economic influences that operate through these decisions. METHODS Using data from the 2001 PAP-FAM Tunisian survey, we estimate the duration and probability models of these birth control decisions. RESULTS In Tunisia, family ties and socio-cultural environment appear to hamper fertility regulation that operates through the above decisions. This is notably the case for couples whose marriages are arranged by the extended family or who benefit from financial support from both parental families. CONCLUSION This calls for family planning policies that address more the extended families.
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Affiliation(s)
- Olfa Frini
- grid.424444.60000 0001 1103 8547Institut Supérieur de Comptabilité & d’Administration Des Entreprises, Manouba University, Tunis, Tunisia
| | - Christophe Muller
- grid.5399.60000 0001 2176 4817Aix-Marseille Univ, CNRS, AMSE, Marseille, France
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Diamond‐Smith N, Puri M, Neuhaus J, Weiser S, Kadiyala S. Do changes in women's household status in Nepal improve access to food and nutrition? MATERNAL & CHILD NUTRITION 2022; 18:e13374. [PMID: 35615780 PMCID: PMC9218303 DOI: 10.1111/mcn.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/08/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Women's nutritional status remains poor in South Asia, impacting maternal and infant health outcomes. Women's household status is also low, as evidenced by eating behaviours. We started with triadic qualitative interviews with newly married women, husbands and mothers-in-law to explore the link between women's status and eating patterns, followed by longitudinal data from a cohort of 200 newly married women in rural Nepal to measure associations over time. Quantitative data were collected every 6 months for 18 months (four rounds of data) between 2018 and 2020. Interviews suggested that household relationships, women's status, and how much and what types of food she was given were intricately linked. Using mixed effects logistic regression models, we explore the association between markers of changing women's status (becoming pregnant, giving birth and working outside the home) on two outcomes (eating last always/usually and achieving minimum dietary diversity). We also explore for interaction between women's status and household food insecurity. Pregnancy increases women's dietary diversity, but this is not sustained post-partum. Women who work outside the home are less likely to eat last in the household. Food insecurity is associated with both the order of household eating and dietary diversity. Interactions between food insecurity and giving birth suggested that women who give birth in food insecure households are more likely to eat last in the household. Changes in women's household status are associated with some improvements in dietary diversity and order of household eating, but the associations are not long-lasting and depend on food security status.
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Affiliation(s)
- Nadia Diamond‐Smith
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Mahesh Puri
- Center for Research on Environment, Health and Population ActivitiesKathmanduNepal
| | - John Neuhaus
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Sheri Weiser
- Department of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Diamond-Smith N, Mitchell A, Cornell A, Dahal M, Gopalakrishnan L, Johnson M, Weiser S, Puri M. The development and feasibility of a group-based household-level intervention to improve preconception nutrition in Nawalparasi district of Nepal. BMC Public Health 2022; 22:666. [PMID: 35387647 PMCID: PMC8984665 DOI: 10.1186/s12889-022-12980-w] [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: 11/16/2021] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background In a setting such as Nepal with malnutrition and persistent poor maternal and infant health outcomes, developing interventions to improve the nutrition of preconception and pregnant women is essential. Objective The objectives of this paper are to describe the full design process of an intervention for newly married women, their husbands, and mothers-in-law to improve maternal nutrition and gender norms, and findings from the feasibility and acceptability pilot. Methods In this paper we describe the three phases of the design of an intervention in rural Nepal. We first conducted a mixed methods formative phase which included in depth interviews with newly married women, their husbands and mothers-in-law (N=60) and a longitudinal study for 18 months with 200 newly married women. We then designed of a household level, group, intervention, in close partnership with community members. Finally, we conducted a pilot intervention with 90 participants and collected both pre/post survey data and in-depth qualitative interviews with a subset (N= 30). All participants from all phases of the study lived in Nawalparasi district of Nepal. Qualitative data was analyzed using a thematic analysis, with inductive and deductive themes and quantitative data was analyzed using descriptive statistics. Results Our formative work highlighted lack of awareness about nutrition, and how women eating last, limited mobility, household and community inequitable gender norms and poor household-level communication contributed to low quality diets. Thus we designed Sumadhur, an intervention that brought groups of households (newly married wife, husband, and mother-in-law) together weekly for four months to strengthen relationships and gain knowledge through interactive content. We found Sumadhur to be highly feasible and acceptable by all respondents, with most (83%) attending 80% of sessions or more and 99% reporting that they would like it to continue. Pre/post surveys showed a decrease in the proportion of women eating last and increase in knowledge about nutrition in preconception and pregnancy. Qualitative interviews suggested that respondents felt it made large impacts on their lives, in terms of strengthening relationships and trust, understanding each other, and changing behaviors. Conclusions We show how a designing an intervention in close partnership with the target recipients and local stakeholders can lead to an intervention that is able to target complicated and culturally held practices and beliefs, positively benefit health and wellbeing, and that is very well received. Trial registration ClinicalTrials.gov NCT04383847, registered 05/12/2020 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12980-w.
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Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
| | - Ashley Mitchell
- University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
| | | | - Minakshi Dahal
- Center for Research on Environment Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
| | | | - Mallory Johnson
- University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
| | - Sheri Weiser
- University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
| | - Mahesh Puri
- Center for Research on Environment Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
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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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Food insecurity and low access to high-quality food for preconception women in Nepal: the importance of household relationships. Public Health Nutr 2020; 23:2737-2745. [PMID: 32468970 PMCID: PMC7477366 DOI: 10.1017/s1368980020000579] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: Women in South Asia, including Nepal, have some of the poorest nutritional indicators globally, leading to poor maternal and child health outcomes. Nepal also suffers from high levels of household food insecurity, and newly married women are at high risk. Intra-household relationships may mediate the relationship between food insecurity and women’s nutrition in Nepal for newly married women. Our aim is to understand how newly married, preconception, women’s food consumption changes when she enters her husband’s home, compared with her natal home. We also explore whether relationship quality with husbands and mothers-in-law mediates the association between food insecurity and eating less high-quality food, using structural equation modelling. Design: Cross-sectional survey data. Setting: Rural Nepal in 2018. Participants: Data were collected from 200 newly married, preconception women. Results: Women had poor diet quality, and most ate fewer high-quality foods important for pregnancy in their marital, compared with natal, home. Higher quality relationships with mothers-in-laws mediated the association between food insecurity and a woman eating fewer high-quality foods in her marital, compared with natal, home. Relationship quality with husbands was not associated with changes in food consumption. Conclusions: Preconception, newly married women in Nepal are eating less high-quality foods important for women’s health during the preconception period – a key period for avoiding adverse maternal and infant health outcomes. Relationships with mothers-in-law are key to women’s access to high-quality food, suggesting that interventions aiming to improve maternal and child nutrition should target all household members.
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