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Singh M, Shekhar C, Gupta J. Distribution and determinants of early marriage and motherhood: a multilevel and geospatial analysis of 707 districts in India. BMC Public Health 2024; 24:2844. [PMID: 39415110 DOI: 10.1186/s12889-024-20038-2] [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: 01/30/2024] [Accepted: 09/10/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND Early marriage and motherhood have long been prevalent in India, with 44.5% of women aged 20-24 reporting marriage before 18 in NFHS 3 (2005-2006), dropping to 26.8% in NFHS 4 (2015-2016). Early motherhood has also seen a significant decline, with first births by age 18 decreasing from 34.3% in NFHS I to 8.2% in NFHS V. Despite these improvements, significant regional disparities persist due to social, normative, and legal factors. This study investigates the spatial heterogeneity of early marriage and motherhood across Indian districts, offering a multilevel analysis that reveals critical local variations often obscured at broader levels. Understanding these patterns is crucial for targeted policy interventions and addressing the root causes of early marriage and motherhood. METHODS Utilizing data from the fifth round of National Family Health Survey, this study employs multilevel logistic regression and geospatial analysis to assess the determinants and spatial distribution of early marriage and early motherhood among ever-married women in India. The analysis incorporates individual, household, and community-level variables, complemented by spatial analysis techniques, including Empirical Bayes Bivariate Moran's I values and LISA cluster maps, to identify regional patterns and hotspots. RESULTS This study revealed that educational attainment emerged as a critical determinant, with uneducated women significantly more likely to marry early. Socioeconomic factors, such as poverty and limited mass media exposure, also heightened the risk of early marriage and motherhood. Caste and religion were significantly associated with these events, with marginalized groups facing higher prevalence. Spatial analysis revealed significant geographic disparities, with central and eastern regions showing higher concentrations of early marriage and motherhood. District-level characteristics and the influence of neighboring districts were also significant, highlighting the importance of localized interventions. CONCLUSIONS The findings underscore the critical role of education, economic empowerment, and media literacy in mitigating early marriage and motherhood risks. The study calls for multi-sectoral interventions in geographical hotspots to break the cycle of early family formation and promote reproductive health. Policies enhancing educational opportunities, addressing economic disadvantages, and considering district-specific factors are essential. Comprehensive strategies are necessary to empower women, foster reproductive health, and address the multifaceted nature of early marriage and motherhood in India.
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Affiliation(s)
- Mayank Singh
- Department of Epidemiology and Biostatistics, KAHER, Bangalore, 590010, Karnataka, India
| | - Chander Shekhar
- Department of Fertility & Social Demography, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India, 400088
| | - Jagriti Gupta
- Department of Fertility & Social Demography, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India, 400088.
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Austrian K, Maluccio JA, Soler-Hampejsek E, Muluve E, Aden A, Wado YD, Abuya B, Kangwana B. Long-term impacts of a cash plus program on marriage, fertility, and education after six years in pastoralist Kenya: A cluster randomized trial. SSM Popul Health 2024; 26:101663. [PMID: 38577063 PMCID: PMC10992718 DOI: 10.1016/j.ssmph.2024.101663] [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: 12/08/2023] [Revised: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
Background Preventing early marriage by increasing girls education has shown promise. We assessed the effects of a two-year cash plus program on marriage and fertility in a pastoralist setting in Northeastern Kenya, six years after it began. Methods A prospective 80-cluster randomized trial followed 2,147 girls 11-14 years old starting in 2015, re-interviewing 94.2% in 2021. Interventions included community dialogues (violence prevention), a conditional cash transfer (education), health and life skills training (health), and financial literacy (wealth creation). Villages were randomized to one of four study arms: (1) violence prevention only (V-only); (2) + education (VE); (3) + health (VEH); or (4) + wealth creation (VEHW). We used analysis of covariance to estimate intent-to-treat impacts of each study arm with an education component, as well as a pooled (weighted average) study arm combining VE, VEH and VEHW, in reference to V-only, four years after the intervention ended when girls were 17-20 years old. Findings Base specification estimates show reductions in the primary outcomes, though none statistically significant in the full sample. Estimates with extended controls are larger and the pooled study arm had significantly lower marriage and pregnancy. There are considerably larger statistically significant effects for the baseline out-ofschool subsample. Pooled estimates indicate 18.2 percentage point lower marriage compared to V-only and 15.1 percentage point lower pregnancy. For the same group pooled estimates indicate a 27.9 percentage point increase in current enrollment (compared to 7.1% in V-only) and a 1.8 grades increase (compared to 1.2 in V-only). Conclusion This study shows the potential for interventions in early adolescence with an education component to delay marriage and fertility into late adolescence and early adulthood in a marginalized and socially conservative setting with low education and high rates of child marriage.
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Affiliation(s)
- Karen Austrian
- GIRL Center, Population Council, PO Box 17643-00500, Nairobi, Kenya
| | - John A. Maluccio
- Department of Economics, Middlebury College, Middlebury, VT, USA
| | | | - Eva Muluve
- Population Council – Kenya, Nairobi, Kenya
| | | | | | - Benta Abuya
- African Population and Health Research Center, Nairobi, Kenya
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Pujar A, Howard-Merrill L, Cislaghi B, Lokamanya K, Prakash R, Javalkar P, Raghavendra T, Beattie T, Isac S, Gafos M, Heise L, Bhattacharjee P, Ramanaik S, Collumbien M. Boys' perspectives on girls' marriage and school dropout: a qualitative study revisiting a structural intervention in Southern India. CULTURE, HEALTH & SEXUALITY 2024; 26:701-716. [PMID: 37548151 DOI: 10.1080/13691058.2023.2241525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
Girls' education has for many decades been central to the global development agenda, due to its positive impact on girls' health and wellbeing. In this paper, the authors revisit boys' attitudes, behaviours and norms related to girls' education, following the Samata intervention to prevent girls' school dropouts in Northern-Karnataka, South India. Data were collected from 20 boys in intervention villages before and after the intervention, and analysis was undertaken using a thematic-framework approach. Findings suggest that while boys did hold some attitudes and beliefs that supported girls' education and delayed-marriage, these remained within the framework of gender-inequitable norms concerning girls' marriageability, respectability/family-honour. Participants criticised peers who sought to jeopardise girls' respectability by teasing and community gossip about girls-boys' communication in public. Boys who rejected prevailing norms of masculinity were subjected to gossip, ridicule and violence by the community. Boys' attitudes and beliefs supported girls' education but were conditional on the maintenance of gendered hierarchies at household and interpersonal levels. Social norms concerning girls' honour, respectability and the role of boys as protectors/aggressors appeared to influence boys' response to girls' school dropouts. Future interventions aiming to address girls' education and marriage must invest time and resources to ensure that intervention components targeting boys are relevant, appropriate and effective.
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Affiliation(s)
- Ashwini Pujar
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
| | - Lottie Howard-Merrill
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Ben Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Kavitha Lokamanya
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
| | - Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Prakash Javalkar
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
| | | | - Tara Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Shajy Isac
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health and School of Nursing, Baltimore, MA, USA
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Martine Collumbien
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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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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Shah P, Kabuti R, Beksinska A, Nyariki E, Babu H, Kungu M, Jama Z, Ngurukiri P, Kaul R, Kyegombe N, Medley GF, Devries K, Seeley J, Weiss HA, Beattie TS, Kimani J. Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya. BMJ Open 2023; 13:e078618. [PMID: 38114279 DOI: 10.1136/bmjopen-2023-078618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya. BACKGROUND Younger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use problems. This study aimed to understand factors in childhood and adolescence that shape the vulnerability to underage sex work initiation. DESIGN Building on previous qualitative research with this cohort, analysis of behavioural-biological cross-sectional data using hierarchical logistic regression. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi, and between June and December 2019, completed a baseline behavioural-biological survey. Measurement tools included WHO Adverse Childhood Experiences, Alcohol, Smoking and Substance Involvement Screening Test and questionnaires on sociodemographic information, sexual risk behaviours and gender-based violence. Descriptive statistics and logistic regression were conducted using hierarchical modelling. RESULTS Of the 1003 FSWs who participated in the baseline survey (response rate 96%), 176 (17.5%) initiated sex work while underage (<18 years). In the multivariable analysis, factors associated with entering sex work while underage included incomplete secondary school education (aOR=2.82; 95% CI=1.69 to 4.73), experiencing homelessness as a child (aOR=2.20; 95% CI=1.39 to 3.48), experiencing childhood physical or sexual violence (aOR=1.85; 95% CI=1.09 to 3.15), young age of sexual debut (≤15 years) (aOR=5.03; 95% CI=1.83 to 13.79) and being childless at time of sex work initiation (aOR=9.80; 95% CI=3.60 to 26.66). CONCLUSIONS Lower education level and childhood homelessness, combined with sexual violence and sexual risk behaviours in childhood, create pathways to underage initiation into sex work. Interventions designed for girls and young women at these pivotal points in their lives could help prevent underage sex work initiation and their associated health, social and economic consequences.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Graham F Medley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karen Devries
- Department of Population Health, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Helen Anne Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
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Machingura F, Busza J, Jamali GM, Makamba M, Mushati P, Chiyaka T, Hargreaves J, Hensen B, Birdthistle I, Cowan FM. Facilitators and barriers to engaging with the DREAMS initiative among young women who sell sex aged 18-24 in Zimbabwe: a qualitative study. BMC Womens Health 2023; 23:257. [PMID: 37173783 PMCID: PMC10182710 DOI: 10.1186/s12905-023-02374-4] [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: 10/25/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW) are at high risk of contracting HIV and exchanging sex for financial or material support heightens their risk. In Zimbabwe, the DREAMS initiative integrated education and employment opportunities within HIV health promotion and clinical services for vulnerable young women, including those who sell sex. While most participants accessed health services, fewer than 10% participated in any social programmes. METHODS We conducted semi-structured qualitative interviews with 43 young women aged 18-24 to understand their experiences of engaging with the DREAMS programme. We purposively sampled participants for diversity in level of education, type and location of selling sex. We analysed the data by applying the Theoretical Domains Framework to explore facilitators and barriers to engaging with DREAMS. RESULTS Eligible women were motivated by hopes of escaping poverty, and their longer-term engagement was sustained through exposure to new social networks, including friendships with less vulnerable peers. Barriers included opportunity costs and expenses such as transport or equipment required for job placements. Participants also described pervasive stigma and discrimination related to their involvement in selling sex. Interviews highlighted the young women's struggles in a context of entrenched social and material deprivation and structural discrimination that hindered their ability to take up most of the social services offered. CONCLUSIONS This study demonstrates that while poverty was a key driver of participation in an integrated package of support, it also constrained the ability of highly vulnerable young women to benefit fully from the DREAMS initiative. Multi-layered HIV prevention approaches such as DREAMS that seek to alter complex and longstanding social and economic deprivation address many of the challenges faced by YWSS but will only succeed if the underlying drivers of HIV risk among YWSS are also addressed.
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Affiliation(s)
- Fortunate Machingura
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe.
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Gracious Madimutsa Jamali
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Memory Makamba
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - James Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Bernadette Hensen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Isolde Birdthistle
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Frances Mary Cowan
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Al Imam MH, Jahan I, Das MC, Bashar SMK, Khan A, Muhit M, Power R, Akbar D, Badawi N, Khandaker G. SUpporting People in extreme POverty with Rehabilitation and Therapy (SUPPORT CP): a trial among families of children with cerebral palsy in Bangladesh. Dev Med Child Neurol 2022; 65:773-782. [PMID: 36335570 DOI: 10.1111/dmcn.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022]
Abstract
AIM To test the efficacy of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) programme in improving health-related quality of life (HRQoL) and motor function of children with cerebral palsy (CP) and gain in social capital to their ultra-poor families in rural Bangladesh. METHOD This was an open-label cluster randomized control trial. Children with CP aged 5 years or under were randomly allocated to three arms; Arm A: IMCBR; Arm B: community-based rehabilitation (CBR); and Arm C: care-as-usual. The CBR was modified with phone follow-up followed by home-based CBR at 2.5 months post-enrolment because of the COVID-19 pandemic. Intention-to-treat analysis was performed. RESULTS Twenty-four clusters constituting 251 children-primary caregivers' dyads were assigned to three arms (Arm A = 80; Arm B = 82; Arm C = 89). Between baseline and endline, the percentage mean change in the physical functioning domain of HRQoL was highest in Arm A (30.0%) with a significant mean difference between Arm A and Arm B (p = 0.015). Improvement in the mean social capital score was significantly higher in Arm A compared to Arm C (p < 0.001). INTERPRETATION The findings suggest that IMCBR could improve the HRQoL of children with CP and the social capital of their ultra-poor families. Long-term follow-up of the trial participants and future exploration of such interventions are essential. The integrated livelihood and CBR programme holds potential to improve health and well-being of children with CP and their ultra-poor families.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Sk Md Kamrul Bashar
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Arifuzzaman Khan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Rosalie Power
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, Queensland, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, The University of Sydney, Sydney, Australia
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Holroyd TA, Yan SD, Srivastava V, Srivastava A, Wahl B, Morgan C, Kumar S, Yadav AK, Jennings MC. Designing a Pro-Equity HPV Vaccine Delivery Program for Girls Who Have Dropped Out of School: Community Perspectives From Uttar Pradesh, India. Health Promot Pract 2022; 23:1039-1049. [PMID: 34636268 DOI: 10.1177/15248399211046611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
India experiences a substantial burden of cervical cancer and accounts for nearly one third of cervical cancer deaths worldwide. While human papillomavirus (HPV) vaccines have been introduced subnationally in some states, HPV has not yet been rolled out nationally. Given the target age group, schools are the most common delivery channel for HPV vaccines, but this fails to account for local girls who never attended or no longer attend school. We conducted a qualitative, design-informed, community-based study conducted in Uttar Pradesh, India. We assessed facilitators and barriers among out-of-school girls and proposed program characteristics to inform the design of pro-equity HPV vaccine delivery programs for out-of-school girls. Programs should improve parental knowledge of the risk of cervical cancer, engage vaccinated girls as vaccine champions, utilize varied media options for low-literacy populations, and ensure that HPV vaccine services are accessible and flexible to accommodate out-of-school girls. In areas with poor or irregular school attendance among adolescent girls, HPV vaccine coverage will remain suboptimal until programs can effectively address their needs and reach this priority population. Our findings present a meaningful opportunity for program planners to purposefully design HPV vaccination programs according to these parameters, rather than modifying existing programs to include HPV vaccine. Adolescent girls, their parents, and other community members should be involved in program design to ensure that the program can effectively meet the needs of adolescent girls who are not in school.
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Affiliation(s)
- Taylor A Holroyd
- Johns Hopkins School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Baltimore, MD, USA
| | - Shirley D Yan
- Johns Hopkins School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Baltimore, MD, USA
| | | | | | - Brian Wahl
- Johns Hopkins School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Baltimore, MD, USA
| | - Christopher Morgan
- Jhpiego, Baltimore, MD, USA.,University of Melbourne, Melbourne, Victoria, Australia
| | | | - Amit K Yadav
- MAMTA Health Institute for Mother and Child, Lucknow, Uttar Pradesh, India
| | - Mary Carol Jennings
- Johns Hopkins School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Baltimore, MD, USA
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Wells JCK, Cole TJ, Cortina-Borja M, Sear R, Leon DA, Marphatia AA, Murray J, Wehrmeister FC, Oliveira PD, Gonçalves H, Oliveira IO, Menezes AMB. Life history trade-offs associated with exposure to low maternal capital are different in sons compared to daughters: Evidence from a prospective Brazilian birth cohort. Front Public Health 2022; 10:914965. [PMID: 36203666 PMCID: PMC9532015 DOI: 10.3389/fpubh.2022.914965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/10/2022] [Indexed: 01/22/2023] Open
Abstract
Background Environmental exposures in early life explain variability in many physiological and behavioural traits in adulthood. Recently, we showed that exposure to a composite marker of low maternal capital explained the clustering of adverse behavioural and physical traits in adult daughters in a Brazilian birth cohort. These associations were strongly mediated by whether or not the daughter had reproduced by the age of 18 years. Using evolutionary life history theory, we attributed these associations to trade-offs between competing outcomes, whereby daughters exposed to low maternal capital prioritised investment in reproduction and defence over maintenance and growth. However, little is known about such trade-offs in sons. Methods We investigated 2,024 mother-son dyads from the same birth cohort. We combined data on maternal height, body mass index, income, and education into a composite "maternal capital" index. Son outcomes included reproductive status at the age of 18 years, growth trajectory, adult anthropometry, body composition, cardio-metabolic risk, educational attainment, work status, and risky behaviour (smoking, violent crime). We tested whether sons' early reproduction and exposure to low maternal capital were associated with adverse outcomes and whether this accounted for the clustering of adverse outcomes within individuals. Results Sons reproducing early were shorter, less educated, and more likely to be earning a salary and showing risky behaviour compared to those not reproducing, but did not differ in foetal growth. Low maternal capital was associated with a greater likelihood of sons' reproducing early, leaving school, and smoking. High maternal capital was positively associated with sons' birth weight, adult size, and staying in school. However, the greater adiposity of high-capital sons was associated with an unhealthier cardio-metabolic profile. Conclusion Exposure to low maternal investment is associated with trade-offs between life history functions, helping to explain the clustering of adverse outcomes in sons. The patterns indicated future discounting, with reduced maternal investment associated with early reproduction but less investment in growth, education, or healthy behaviour. However, we also found differences compared to our analyses of daughters, with fewer physical costs associated with early reproduction. Exposure to intergenerational "cycles of disadvantage" has different effects on sons vs. daughters, hence interventions may have sex-specific consequences.
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Affiliation(s)
- Jonathan C. K. Wells
- Policy, Population and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Tim J. Cole
- Policy, Population and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mario Cortina-Borja
- Policy, Population and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Rebecca Sear
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David A. Leon
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Akanksha A. Marphatia
- Policy, Population and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Geography, University of Cambridge, Cambridge, United Kingdom
| | - Joseph Murray
- Federal University of Pelotas – Postgraduate Program in Epidemiology, Pelotas, Brazil
| | | | - Paula D. Oliveira
- Federal University of Pelotas – Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Helen Gonçalves
- Federal University of Pelotas – Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Isabel O. Oliveira
- Federal University of Pelotas – Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Ana Maria B. Menezes
- Federal University of Pelotas – Postgraduate Program in Epidemiology, Pelotas, Brazil
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Schaaf M, Boydell V, Topp SM, Iyer A, Sen G, Askew I. A summative content analysis of how programmes to improve the right to sexual and reproductive health address power. BMJ Glob Health 2022; 7:bmjgh-2022-008438. [PMID: 35443940 PMCID: PMC9021801 DOI: 10.1136/bmjgh-2022-008438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/27/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses summative content analysis to describe how sexual and reproductive health (SRH) programmes in low-income and middle-income countries explicitly and implicitly aim to alter relations of power. METHODS Content analysis is a qualitative approach to analysing textual data; in our analysis, peer-reviewed articles that describe programmes aiming to alter power relations to improve SRH constituted the data. We searched three databases, ultimately including 108 articles. We extracted the articles into a spreadsheet that included basic details about the paper and the programme, including what level of the social ecological model programme activities addressed. RESULTS The programmes reviewed reflect a diversity of priorities and approaches to addressing power, though most papers were largely based in a biomedical framework. Most programmes intervened at multiple levels simultaneously; some of these were 'structural' programmes that explicitly aimed to shift power relations, others addressed multiple levels using a more typical programme theory that sought to change individual behaviours and proximate drivers. This prevailing focus on proximate behaviours is somewhat mismatched with the broader literature on the power-related drivers of SRH health inequities, which explores the role of embedded norms and structures. CONCLUSION This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, USA
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Victoria Boydell
- School of Health and Social Care, University of Essex Faculty of Science and Health, Colchester, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Aditi Iyer
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
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Marphatia AA, Wells JCK, Reid AM, Yajnik CS. Biosocial life-course factors associated with women's early marriage in rural India: The prospective longitudinal Pune Maternal Nutrition Study. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 177:147-161. [PMID: 36787733 DOI: 10.1002/ajpa.24408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES By convention, women's early marriage is considered a sociocultural decision sensitive to factors acting during adolescence such as poverty, early menarche, and less education. Few studies have examined broader risk factors in the natal household prior to marriage. We investigated whether biosocial markers of parental investment through the daughters' life-course were associated with early marriage risk in rural India. We used an evolutionary perspective to interpret our findings. MATERIALS AND METHODS A prospective cohort recruited mothers at preconception. Children were followed from birth to age 21 years. Multivariable logistic regression models estimated odds ratios of marrying early (<19 years) associated first with wealth, age at menarche and education, and then with broader markers of maternal phenotype, natal household characteristics, and girls' growth trajectories. Models adjusted for confounders. RESULTS Of 305 girls, 71 (23%) had married early. Early married girls showed different patterns of growth compared to unmarried girls. Neither poverty nor early menarche predicted early marriage. Girls' non-completion of lower secondary school predicted early marriage, explaining 19% of the variance. Independent of girls' lower schooling, nuclear household, low paternal education, shorter gestation, and girls' poor infant weight gain were associated with marrying early, explaining in combination 35% of the variance. DISCUSSION Early marriage reflects "future discounting," where reduced parental investment in daughters' somatic and educational capital from early in her life favors an earlier transition to the life-course stage when reproduction can occur. Interventions initiated in adolescence may occur too late in the life-course to effectively delay women's marriage.
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Affiliation(s)
| | - Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alice M Reid
- Department of Geography, University of Cambridge, Cambridge, UK
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Marphatia AA, Saville NM, Manandhar DS, Cortina-Borja M, Wells JCK, Reid AM. Quantifying the association of natal household wealth with women's early marriage in Nepal. PeerJ 2021; 9:e12324. [PMID: 35003910 PMCID: PMC8684741 DOI: 10.7717/peerj.12324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Women's early marriage (<18 years) is a critical global health issue affecting 650 million women worldwide. It is associated with a range of adverse maternal physical and mental health outcomes, including early childbearing, child undernutrition and morbidity. Poverty is widely asserted to be the key risk factor driving early marriage. However, most studies do not measure wealth in the natal household, but instead, use marital household wealth as a proxy for natal wealth. Further research is required to understand the key drivers of early marriage. METHODS We investigated whether natal household poverty was associated with marrying early, independently of women's lower educational attainment and broader markers of household disadvantage. Data on natal household wealth (material asset score) for 2,432 women aged 18-39 years was used from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Different early marriage definitions (<15, <16, <17 and <18 years) were used because most of our population marries below the conventional 18-year cut-off. Logistic mixed-effects models were fitted to estimate the probabilities, derived from adjusted Odds Ratios, of (a) marrying at different early ages for the full sample and for the uneducated women, and (b) being uneducated in the first place. RESULTS Women married at median age 15 years (interquartile range 3), and only 18% married ≥18 years. Two-thirds of the women were entirely uneducated. We found that, rather than poverty, women's lower education was the primary factor associated with early marriage, regardless of how 'early' is defined. Neither poverty nor other markers of household disadvantage were associated with early marriage at any age in the uneducated women. However, poverty was associated with women being uneducated. CONCLUSION When assets are measured in the natal household in this population, there is no support for the conventional hypothesis that household poverty is associated with daughters' early marriage, but it is associated with not going to school. We propose that improving access to free education would both reduce early marriage and have broader benefits for maternal and child health and gender equality.
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Affiliation(s)
- Akanksha A. Marphatia
- Department of Geography, University of Cambridge, Cambridge, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Naomi M. Saville
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Jonathan C. K. Wells
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Alice M. Reid
- Department of Geography, University of Cambridge, Cambridge, United Kingdom
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Bokaie M, Bostani Khalesi Z, Ashoobi MT. Challenges and strategies to end child marriage. Int J Adolesc Med Health 2021; 33:75-81. [PMID: 33866695 DOI: 10.1515/ijamh-2021-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Child marriage is one of the most important challenges of the current era that threatens women's health and violates human rights. The present study aimed to systematically review studies evaluating the challenges and strategies to overcome child marriage. CONTENT Medical databases (CINAHL, EMBASE, MEDLINE, EMBASE, PsycINFO, SCOPUS, Web of Science, ProQuest Nursing and Allied Health Source, and Social Science Research Network, as databases for English studies and IranMedex, Google Scholar, SID, Magiran, and Iran Doc as databases for Persian studies) were systematically searched from January 2010 to February 2020. To better identify appropriate studies, reference lists of relevant studies were searched. All potentially relevant abstracts and full-text were screened by two independent reviewers. Disagreements between two reviewers that could not be resolved were resolved via arbitration or consultation of a third author. SUMMARY AND OUTLOOK From 225 articles included in this review, 16 research articles met our inclusion criteria. Most of the articles were dedicated to negative health outcomes related to child marriage. Ten studies addressed the program of overcoming the Child marriage and six studies reported challenges of it. Although, many studies have shown the efficacy of strategies to decline Child marriage. On the basis of the available evidence, it seems there are a number of obstacles to end Child marriage. To delineate the most effective strategy to end Child marriage is required further research.
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Affiliation(s)
- Mahshid Bokaie
- Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Bostani Khalesi
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Taghi Ashoobi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Pundir P, Saran A, White H, Subrahmanian R, Adona J. Interventions for reducing violence against children in low- and middle-income countries: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1120. [PMID: 37016609 PMCID: PMC8356324 DOI: 10.1002/cl2.1120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Background More than half of the children in the world experience some form of interpersonal violence every year. As compared with high-income countries, policy responses in low- and middle-income countries (LMICs) are limited due to resource constraints and paucity of evidence for effective interventions to reduce violence against children in their own contexts, amongst other factors. Objectives The aim of this evidence and gap map (EGM) is to provide an overview of the existing evidence available and to identify gaps in the evidence base on the effectiveness of interventions to reduce violence against children in LMICs. This report covers evidence published in English; a follow-up study is under preparation focusing on evidence in five additional languages-Arabic, Chinese, French, Portuguese and Spanish. Methods The intervention-outcome framework for this EGM is based on INSPIRE-Seven Strategies for Ending Violence against Children, published by WHO and other partners in 2016. The seven strategies include implementation and enforcement of laws; norms and values, safe environment; parent-child and caregiver support; income and economic strengthening; response and support services; education and life skills. The search included both academic and grey literature available online. We included impact evaluations and systematic reviews that assessed the effectiveness of interventions to reduce interpersonal violence against children (0-18 years) in LMICs (World Bank, 2018b). Interventions targeting subpopulation of parents, teachers and caregivers of 0-18 years' age group were also included. A critical appraisal of all included studies was carried out using standardised tools. Results The map includes 152 studies published in English of which 55 are systematic reviews and 97 are impact evaluations. Most studies in the map are from Sub-Saharan Africa. Education and life skills are the most widely populated intervention area of the map followed by income and economic strengthening interventions. Very few studies measure impact on economic and social outcomes, and few conduct cost-analysis. Conclusion More studies focusing on low-income and fragile and conflict-affected settings (FCS) and studying and reporting on cost-analysis are required to address gaps in the evidence. Most interventions covered in the literature focused on addressing a wide range of forms of violence and harm, which limited understanding of how and for whom the interventions work in a given context, for specific forms of violence. More impact evaluation studies are required that assess specific forms of violence, gendered effects of interventions and on diverse social groups in a given context, utilising mixed methods.
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McDougal L, Shakya H, Dehingia N, Lapsansky C, Conrad D, Bhan N, Singh A, McDougal TL, Raj A. Mapping the patchwork: Exploring the subnational heterogeneity of child marriage in India. SSM Popul Health 2020; 12:100688. [PMID: 33319026 PMCID: PMC7726340 DOI: 10.1016/j.ssmph.2020.100688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022] Open
Abstract
Despite dramatic reductions in child marriage over the past decade, more than one in four girls in India still marry before reaching age 18. This practice is driven by a complex interplay of social and normative beliefs and values that are inadequately represented in national- or even state-level analyses of the drivers of child marriage. A geographic lens was employed to assess variations in child marriage prevalence across Indian districts, identify hot and cold spots, and quantify spatial dependence and heterogeneity in factors associated with district levels of child marriage. Data were derived from the 2015-16 National Family Health Survey and the 2011 India Census, and represent 636 districts in total. Analyses included global Moran's I, LISAs, spatial Durbin regression and geographically weighted regression. This study finds wide inter- and intra-state heterogeneity in levels of child marriage across India. District levels of child marriage were strongly influenced by geographic characteristics, and even more so by the geographic characteristics of neighboring districts. Districts with higher levels of female mobile phone access and newspaper use had lower levels of child marriage. These relationships, however, were all subject to substantial local spatial heterogeneity. The results indicate that characteristics of neighboring districts, as well as characteristics of a district itself, are important in explaining levels of child marriage, and that those relationships are not constant across India. Child marriage reduction programs that are targeted within specific administrative boundaries may thus be undermined by geographic delineations that do not necessarily reflect the independent and interdependent characteristics of the communities who live therein. The geographic, social and normative characteristics of local communities are key considerations in future child marriage programs and policies. Child marriage prevalence is highly heterogeneous across Indian districts. Districts near state border districts tend to have higher levels of child marriage. Characteristics of districts and their neighbors influence child marriage. Geography affects the relationship between social normative factors and child marriage. Child marriage interventions may require joint action across states.
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Affiliation(s)
- Lotus McDougal
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
| | - Holly Shakya
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
| | - Nabamallika Dehingia
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
| | - Charlotte Lapsansky
- United Nations Children's Fund (UNICEF), UNICEF House 3, United Nationsl Plaza, New York, NY, 10017, USA
| | - David Conrad
- United Nations Children's Fund (UNICEF), UNICEF House 3, United Nationsl Plaza, New York, NY, 10017, USA
| | - Nandita Bhan
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
| | - Abhishek Singh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400 088, India
| | - Topher L McDougal
- Kroc School of Peace Studies, University of San Diego, 5998 Alcala Park, San Diego, CA, 92110, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
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Lebni JY, Solhi M, Fard Azar FE, Farahani FK. Qualitative study of social determinants of child marriage in Kurdish regions of Iran: Evidence for health promotion interventions. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:242. [PMID: 33209934 PMCID: PMC7652076 DOI: 10.4103/jehp.jehp_332_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/03/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION One of the most thought-provoking problems in the world is child marriage that is affected by various factors. Therefore, the purpose of this study is to identify the social determinants of child marriage in Kurdish regions of Iran. MATERIALS AND METHODS This qualitative study was conducted using conventional content analysis approach. The participants of the study were 30 Iranian-Kurdish women married under the age of 18 who were selected through purposeful and snowballing sampling. Data collection was conducted through semi-structured interviews and face-to-face interviews and continued until the saturation of concepts was achieved. Graneheim and Lundman method was used to analyze the data, and Guba and Lincoln criteria were used to strengthen the research. RESULTS In general, findings include 5 categories and 17 subcategories: 1 - economic factors (financial problems and economic benefits); 2 - sociocultural factors (social customs, cultural beliefs, community encouragement, social learning, gaining prestige, and social support); 3 - individual factors (physical characteristics, personality traits, lack of awareness of the damaging consequences of early marriage, and fear of the future); 4 - family factors (dysfunctional family, weak awareness of parents, and harm prevention); and 5 - structural factors (high demand, limited access to educational services, and the lack of supportive social and legal structures). CONCLUSION By raising the level of awareness and attitude of girls and their families about the consequences of early marriage, creating the culture of correcting cultural beliefs and social misconceptions, passing appropriate laws, and the use of local and national media to prevent child marriage, this social harm can be reduced.
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Affiliation(s)
- Javad Yoosefi Lebni
- Department Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Solhi
- Department Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farbod Ebadi Fard Azar
- Department Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farideh Khalajabadi Farahani
- Department of Population and Health, National Population Studies and Comprehensive Management Institute, Tehran, Iran
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Prakash R, Beattie TS, Cislaghi B, Bhattacharjee P, Javalkar P, Ramanaik S, Thalinja R, Davey C, Gafos M, Watts C, Collumbien M, Moses S, Isac S, Heise L. Changes in Family-Level Attitudes and Norms and Association with Secondary School Completion and Child Marriage Among Adolescent Girls: Results from an Exploratory Study Nested Within a Cluster-Randomised Controlled Trial in India. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:1065-1080. [PMID: 32720188 DOI: 10.1007/s11121-020-01143-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluated the impact of Samata, a 3-year multilayered intervention among scheduled caste/scheduled tribe (SC/ST) adolescent girls in rural northern Karnataka, on family-level (parents or guardian) attitudes and direct and indirect norms related to child marriage and girl's education. Endline data from 1840 family members were used to assess the effect of Samata on attitudes and norms related to schooling and child marriage, while data from 4097 family members (including 2257 family members at baseline) were used to understand the shifts in attitudes and norms over the period 2014-2017. Overall, we found that the programme had little impact on family-level attitudes and norms. However, there were shifts in some attitudes, norms and perceived sanctions between baseline (when girls were aged 13-14 years) and endline (when girls were aged 15-16 years), with some becoming more progressive (e.g. direct norms related to child marriage) and others more restrictive (e.g. norms around girls completing secondary education and norms related to child marriage and educational drop-out, blaming girls for eve teasing and limiting girls' mobility so as to protect family honour). Moreover, non-progressive norms related to marriage and education were strongly associated with child marriage and secondary school non-completion among adolescent girls in this rural setting. Norms hypothesised to be important for marriage and schooling outcomes were indeed associated with these outcomes, but the intervention was not able to significantly shift these norms. In part, this may have been due to the intervention focusing much of its initial efforts on working with girls alone rather than family members, the relevant reference group. Future interventions that seek to affect norms should conduct formative research to clarify the specific norms affecting the outcome(s) of interest; likewise, programme planners should ensure that all activities engage those most influential in enforcing the norm(s) from the beginning. ClinicalTrials.gov registration number: NCT01996241.
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Affiliation(s)
- Ravi Prakash
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
- India Health Action Trust (IHAT), Bangalore, India.
| | - Tara S Beattie
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Beniamino Cislaghi
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | | | - Calum Davey
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Mitzy Gafos
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Charlotte Watts
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Martine Collumbien
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Stephen Moses
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Shajy Isac
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
- India Health Action Trust (IHAT), Bangalore, India
| | - Lori Heise
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg Institute for Global Public Health and JHU School of Nursing, 615 N. Wolfe Street, Baltimore, MD, USA
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Rath S, Prost A, Samal S, Pradhan H, Copas A, Gagrai S, Rath S, Gope RK, Nair N, Tripathy P, Bhatia K, Rose-Clarke K. Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial. Trials 2020; 21:52. [PMID: 31915039 PMCID: PMC6950906 DOI: 10.1186/s13063-019-3984-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the health and development of adolescents aged 10-19 years is a global health priority. One in five adolescents globally live in India. The Rashtriya Kishor Swasthya Karyakram (RKSK), India's national adolescent health strategy, recommends supporting community-based peer educators to conduct group meetings with boys and girls. Groups aim to give adolescents a space to discuss the social and health issues affecting them and build their capacity to become active community members and leaders. There have been no evaluations of the community component of RKSK to date. In this protocol, we describe the evaluation of the Jharkhand Initiative for Adolescent Health (JIAH), a community intervention aligned with RKSK and designed to improve school attendance, dietary diversity and mental health among adolescent girls aged 10-19 years in rural Jharkhand, eastern India. METHODS The JIAH intervention is delivered by a community youth team consisting of yuva saathis (friends of youth), youth leadership facilitators and livelihood promoters. Teams conduct (a) peer-led Participatory Learning and Action meetings with girls and boys, mobilising adolescents, parents, health workers, teachers and the wider community to make changes for adolescent health and development; (b) group-based youth leadership activities to build adolescents' confidence and resilience; and (c) livelihood promotion with adolescents and their families to provide training and practical skills. We are evaluating the JIAH intervention through a parallel-group, two-arm, superiority, cluster-randomised controlled trial. The unit of randomisation is a geographic cluster of ~1000 people. A total of 38 clusters covering an estimated population of 40,676 have been randomised to control or intervention arms. Nineteen intervention clusters have adolescent groups, youth leadership activities and livelihood promotion. Nineteen control clusters receive livelihood promotion only. Study participants are adolescent girls aged 10-19 years, married or unmarried, in or out of school, living in the study area. Intervention activities are open to all adolescent boys and girls, regardless of their participation in surveys. We will collect data through baseline and endline surveys. Primary trial outcomes are school attendance, dietary diversity and internalising and externalising mental health problems. Secondary outcomes include access to school-related entitlements, emotional or physical violence, self-efficacy and resilience. TRIAL REGISTRATION ISRCTN17206016. Registered on 27 June 2018.
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Affiliation(s)
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | | | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | | | - Komal Bhatia
- Institute for Global Health, University College London, London, UK
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, Bush House NE Wing, London, WC2B 4BG, UK.
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