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Kidman R, Breton E, Mwera J, Zulu A, Behrman J, Kohler HP. Drivers of child marriages for girls: A prospective study in a low-income African setting. Glob Public Health 2024; 19:2335356. [PMID: 38584448 PMCID: PMC11025042 DOI: 10.1080/17441692.2024.2335356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Abstract
Child marriage has adverse consequences for young girls. Cross-sectional research has highlighted several potential drivers of early marriage. We analyse drivers of child marriage using longitudinal data from rural Malawi, where rates of child marriage are among the highest in the world despite being illegal. Estimates from survival models show that 26% of girls in our sample marry before age 18. Importantly, girls report high decision-making autonomy vis-à-vis the decision to marry. We use multivariate Cox proportional hazard models to explore the role of 1) poverty and economic factors, 2) opportunity or alternatives to marriage, 3) social norms and attitudes, 4) knowledge of the law and 5) girls' agency. Only three factors are consistently associated with child marriage. First, related to opportunities outside marriage, girls lagging in school at survey baseline have significantly higher rates of child marriage than their counterparts who were at or near grade level. Second, related to social norms, child marriage rates are significantly lower among respondents whose caregivers perceive that members of their community disapprove of child marriage. Third, knowledge of the law has a positive coefficient, a surprising result. These findings are aligned with the growing qualitative literature describing contexts where adolescent girls are more active agents in child marriages.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, Stony Brook University (State University of New York), Stony Brook, NY, USA
| | - Etienne Breton
- Department of Sociology, University of Pennsylvania, Philadelphia, USA
| | | | | | - Jere Behrman
- Departments of Economics and Sociology, Population Aging Research Center and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Hans-Peter Kohler
- Department of Sociology, Population Aging Research Center and Population Studies Center, University of Pennsylvania, Philadelphia, USA
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Fortin G, Gagnon-Dufresne MC, Bunkeddeko K, Muwereza J, Zinszer K. Barriers to family planning through structural health vulnerabilities: findings from case studies from rural Uganda. Cult Health Sex 2023; 25:1070-1083. [PMID: 36153729 DOI: 10.1080/13691058.2022.2122571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
The burden of maternal mortality in sub-Saharan Africa is the highest in the world. As high fertility rates present an increased risk to women's health, programmes and services have been put in place to increase access to family planning. Several studies have identified sociocultural factors as limiting access to family planning, including male resistance and women's low decision-making power. However, these studies have often used a behavioural approach that anchors barriers to access in women's attitudes or motivations. In 2019, a qualitative evaluation of a family planning programme using a behavioural approach was conducted in rural Uganda, focusing on women's attitudes and unmet needs. With hindsight, we realised that our evaluation was insufficient to adequately capture barriers that extend beyond women's motivations. This paper shares three case studies that we analysed using a structural health vulnerabilities approach. Our analysis highlights political, economic, social and cultural structures that can impede access to family planning. Using a structural health vulnerabilities approach, we identify structural barriers which have their roots in the local realities women face and propose context-specific structural recommendations. Finally, we contrast our initial results with findings the case studies presented to highlight the relevance of taking structural vulnerabilities into account in future family planning programme evaluation and women's sexual and reproductive health studies.
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Affiliation(s)
- Geneviève Fortin
- École de santé publique de l'Université de Montréal (ESPUM), University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP) (Center for Public Health Research), Montreal, QC, Canada
| | - Marie-Catherine Gagnon-Dufresne
- École de santé publique de l'Université de Montréal (ESPUM), University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP) (Center for Public Health Research), Montreal, QC, Canada
| | | | | | - Kate Zinszer
- École de santé publique de l'Université de Montréal (ESPUM), University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP) (Center for Public Health Research), Montreal, QC, Canada
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Billah MA, Khan MMA, Hanifi SMA, Islam MM, Khan MN. Spatial pattern and influential factors for early marriage: evidence from Bangladesh Demographic Health Survey 2017-18 data. BMC Womens Health 2023; 23:320. [PMID: 37340425 DOI: 10.1186/s12905-023-02469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Early marriage is highly prevalent in Bangladesh. It is linked with a range of adverse outcomes, including maternal and child mortality. However, research on regional variations and factors associated with early marriage is scarce in Bangladesh. This study aimed to explore the geographical variations and predictors of early marriage in Bangladesh. METHODS Data of women aged 20-24 in the Bangladesh Demographic and Health Survey 2017-18 were analysed. The occurrence of early marriage was the outcome variable. Explanatory variables were several individual-, household- and community-level factors. Geographical hot spots and cold spots of early marriage were first determined using Global Moran's I statistic. Multilevel mixed-effect Poisson regression was used to determine the association of early marriage with individual-, household-, and community-level factors. RESULTS Almost 59% of women aged 20-24 reported they were married before reached 18. The hotspots of early marriage were mainly concentrated in Rajshahi, Rangpur and Barishal, and the cold spots were in Sylhet and Chattogram divisions. The prevalence of early marriage was lower among higher educated (adjusted prevalence ratio (aPR): 0.45; 95% CI: 0.40, 0.52), and non-Muslim women (aPR: 0.89; 95% CI: 0.79, 0.99) than their counterparts. Higher community-level poverty was significantly associated with early marriage (aPR, 1.16; 95% CI: 1.04, 1.29). CONCLUSION The study concludes that promoting girls' education, awareness-building programs about the adverse effects of early marriage and proper application of the child marriage restraint act, particularly in disadvantaged communities are recommended.
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Affiliation(s)
- Md Arif Billah
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Md Mostaured Ali Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Syed Manzoor Ahmed Hanifi
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - M Mofizul Islam
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Namapara, Mymensingh, 2220, Bangladesh
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Streatfield AJ, Rahman MM, Khan S, Haider MM, Rahman M, Nahar Q, Jamil K. What shapes attitudes on gender roles among adolescents in Bangladesh. Front Public Health 2023; 11:1121858. [PMID: 37056652 PMCID: PMC10088519 DOI: 10.3389/fpubh.2023.1121858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/20/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundIn Bangladesh, large gender differentials exist in outcomes in almost all spheres of life, stemming from conservative norms and attitudes around gender. Adolescence is a crucial period for social-emotional learning that can shape gender norms and attitudes.ObjectiveThe aim of the paper is to investigate the extent to which adolescents hold egalitarian attitudes toward gender roles, and to examine the factors that influence egalitarian gender attitudes.MethodsThe paper uses data from a nationally representative sample survey of 7,800 unmarried girls and 5,523 unmarried boys ages 15–19 years. Adolescents were considered to have egalitarian attitudes on gender role if they disagreed with all the following four unequal gender role statements with regards to socio-economic participation, while respondents who agreed with any one of the four statements were considered to have non-egalitarian attitudes: (1) It is important that sons have more education than daughters, (2) Outdoor games are only for boys, not girls, (3) Household chores are for women only, not for men, even if the woman works outside the home, and (4) Women should not be allowed to work outside the home. Multivariable linear probability regression analysis was implemented to identify the factors shaping attitudes on gender roles.ResultsUnmarried girls and boys differ hugely in their views on gender roles regarding socio economic participation-girls were much more egalitarian than boys (58 vs. 19%). The multivariate linear probability model results show girls and boys who completed at least grade 10 were 31% points and 15% points more likely to have egalitarian views on gender roles respectively, compared to girls and boys with primary or less education. Having strong connection with parents is associated with having egalitarian views on gender roles among girls but not boys. Adolescents' individual attitude on gender role is highly associated with the views of their community peers for both girls and boys. Girls and boys who had participated in adolescent programs were 6–7% points more likely to have egalitarian attitude than those who were not exposed to these programs. Egalitarian views were also significantly higher, by 5% points among girls and 6% points among boys, who were members of social organizations compared to those who were not. Watching television had positive influence on egalitarian attitudes among girls but not among boys. To create a more egalitarian society, both men and women need to hold progressive attitudes toward gender roles. The interventions must be multilevel, influencing adolescents at the personal, interpersonal, communal, and societal levels.
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Affiliation(s)
| | - Md Mahabubur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Shusmita Khan
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - M. Moinuddin Haider
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mizanur Rahman
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kanta Jamil
- Independent Consultant, Fitzroy North, VIC, Australia
- *Correspondence: Kanta Jamil
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Datta BK, Hassan S. An Early Assessment of the 2017 Child Marriage Restraint Act of Bangladesh. Asia Pac J Public Health 2022; 34:463-465. [PMID: 35264017 DOI: 10.1177/10105395221083895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA.,Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Shahidul Hassan
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
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Tewahido D, Worku A, Tadesse AW, Gulema H, Berhane Y. Adolescent girls trapped in early marriage social norm in rural Ethiopia: A vignette-based qualitative exploration. PLoS One 2022; 17:e0263987. [PMID: 35176081 PMCID: PMC8853576 DOI: 10.1371/journal.pone.0263987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Early marriage is not uncommon in Ethiopia, particularly for adolescent girls in rural settings. Social norms are among the factors believed to perpetuate early marriage practices. This qualitative study explores social norms surrounding adolescent girls’ marriage practices in West Hararghe, Ethiopia.
Methods
This study used the qualitative inquiry method to explore social norms in rural Ethiopia. Focus group discussions were conducted with purposively sampled married and unmarried adolescent girls, adolescent boys, and parents. A total of 158 individuals participated in the study, comprising 95 adolescents and 63 parents. Data were collected using locally developed vignettes. A thematic framework analysis approach using the Social Norms Analysis Plot (SNAP) was employed to diagnose and understand social norms.
Results
Adolescent girls’ marriage was found to be mainly influenced by their peers who conform to prevailing social norms. Marrying one’s first suitor was considered an opportunity not to be missed and a symbol of good luck. Relatives, neighbors, and marriage brokers facilitate adolescent girls’ marriage in accordance with the local social norms. Girls usually accept the first marriage proposal regardless of their age, and they are highly expected to do so by their peers, parents, and influential others. Exceptions from the early marriage social norm include adolescent girls determined to continue their education and those having supportive teachers.
Conclusions
In this study context, social norms strongly encourage early marriage and are mainly perpetuated by peers of adolescent girls and influential adults. A strong determination to continue education on the part of girls, strong school performance, and supportive schoolteachers are important conditions for circumventing social norms on early marriage. As social norms evolve slowly, we recommend periodical assessment in order to develop locally appropriate interventions against early marriage.
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Affiliation(s)
- Dagmawit Tewahido
- Nutrition and Behavioral Sciences Department, Addis Continental Institute of Public Health, Addis Ababa, Ethopia
- * E-mail:
| | - Alemayehu Worku
- Epidemiology and Biostatistics Department, Addis Continental Institute of Public Health, Addis Ababa, Ethopia
| | - Amare W. Tadesse
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Hanna Gulema
- Global Health and Health Policy Department, Addis Continental Institute of Public Health, Addis Ababa, Ethopia
| | - Yemane Berhane
- Epidemiology and Biostatistics Department, Addis Continental Institute of Public Health, Addis Ababa, Ethopia
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