BACKGROUND: Women's underage marriage (<18 years) is associated with adverse maternal and child health outcomes. Poverty in the natal household has been widely considered to be a key risk factor for underage marriage, but the evidence base is unreliable. When investigating this issue, most studies use marital wealth inappropriately, as a proxy for wealth in the natal household. In contrast, we investigated whether the timing of women's marriage was associated with the wealth of the households they marry into, and how this may vary by women's education level. This approach allows us to explore a different set of research questions which help to understand the economic value placed on the timing of women's marriage. METHODS: We used data on 3,102 women aged 12-34 years, surveyed within 1 year of marriage, from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Linear mixed-effects regression models investigated independent associations of women's marriage age and education level with marital household wealth, and their interactive effects. Models adjusted for marital household traits. We analysed the full sample, and then only the uneducated women, who comprised a substantial proportion in our sample. RESULTS: In the full sample, we found that each later year of women's marriage was associated with 1.5% lower asset score for those with primary education, and with 0.3% and 1.3% higher asset score for those with lower secondary or secondary/higher education, respectively. For uneducated women, relative to marrying ≤14 years, marrying at 15, 16, 17 and ≥18 years was associated with 1.5%, 4.4%, 2.4% and 6.2% greater marital asset score respectively. CONCLUSION: On average, marrying ≥18 years was associated with greater marital assets for secondary-educated women. There were only very modest benefits in terms of marital household wealth for delaying marriage beyond 16 years for uneducated women or those with low education. These findings elucidate potential trade-offs faced by families, including decisions over how much education, if any, to provide to daughters. They may help to understand the economic rationale underpinning the timing of marriage, and why early marriage remains common despite efforts to delay it.
Akanksha A Marphatia, Naomi M Saville, Dharma S Manandhar et al.
BACKGROUND: Adults aged 21-29 have the highest past-month prevalence of tobacco, alcohol, and illicit drug use in the U.S. Currently, young adults often delay traditional adulthood milestones (e.g., marriage and childbearing), which may impact their household composition and substance use. METHODS: We examined how the past-month prevalence of eight mutually exclusive substance use outcomes varied by household composition among young adults using the 2016-2019 National Surveys on Drug Use and Health (NSDUH) data. Bivariable and multivariable multinomial logistic regression analyses were applied. RESULTS: Among young adults residing with their children, the most common household composition was residing with children and a spouse/partner (16.6%, 95% CI = 16.5-16.8%). Among those residing without children, common household compositions included residing with parents (22.8%, 95% CI = 22.2-23.4%) and residing only with a spouse/partner (17.9%, 95% CI = 17.6-18.3%). Past-month prevalence of binge alcohol, tobacco, and illicit drug use varied by household composition. Residing only with children and a spouse/partner was associated with a low prevalence of most examined substance use patterns. Across household compositions, those residing solely with unrelated individuals had the highest adjusted prevalence of tobacco, drug, and binge alcohol use (13.8%, 95% CI = 12.5-15.1%). CONCLUSIONS: The prevalence of substance use patterns among U.S. young adults varies by household composition. Those residing solely with unrelated individuals had the highest prevalence of tobacco, binge alcohol, and drug use. The presence of a young adult's own children and a spouse/partner is associated with a lower prevalence of most examined substance use patterns. As household compositions continue to diversify, targeted substance use prevention/treatment strategies may be needed.
INTRODUCTION: Sexual and reproductive health and rights (SRHR) are vital for both individual well-being and development. Bangladesh has made long strides in improving SRHR over the last few decades. However, the progress has been uneven across various groups of reproductive-aged females, with the married adolescent girls (MAGs) often being more vulnerable to denial of SRHR than other women. This study intends to develop Balika Bodhu, a combined empowerment and social norm intervention for promoting SRHR among the MAGs and assess its impact. METHODS: The evaluation will employ a mixed-method two-arm Cluster Randomized Controlled Trial (CRCT) design, where Arm 1 receives the intervention, and Arm 2 serves as the control. The trial will cover 32 clusters (villages) in Rajbari Sadar sub-district, randomized into two equally distributed study arms. A total of 1,120 MAGs aged 15-19 years will be randomly selected from the clusters (35 per cluster) to form a cohort. The MAGs, their husbands, selected elderly women (26 per village) and influential community members (26 per village) will receive group sessions in the intervention clusters. The MAGs and their husbands will be interviewed at baseline and endline. A randomly selected cross-sectional sample of community members aged 35-59 years at baseline and endline will also be surveyed to measure attitudes and social norm regarding SRHR of MAGs. Qualitative data will be collected using 32 In-depth Interviews, six Key Informant Interviews, and eight Focus Group Discussions from two intervention villages. Intention-to-treat (ITT) analysis will be performed to assess the impact of the intervention. Narrative analysis and the Grounded Theory approach will be used to analyze the qualitative data. CONCLUSION: Rigorous evaluation of Balika Bodhu should contribute to the literature on what works and what does not in addressing denial of SRHR to MAGs using empowerment and social norm intervention and inform policies and programs. TRIAL REGISTRATION: Clinicaltrials.gov: identifier: NCT06126770; Date: Oct 7, 2023. Version 1.
Peer-reviewed article·PubMed (US National Library of Medicine)·
OBJECTIVE: The objective of the study is to examine the impact of health insurance and social safety net programmes on maternal health service utilisation (MHSU) in Pakistan. DESIGN: Cross-sectional. SETTINGS: Data were obtained from Pakistan Demographic Health Survey 2017-2018. PARTICIPANTS: Out of 12 364 Pakistani ever-married women aged 15-49 years included in the survey sample, 7752 were included in the study. MAIN OUTCOME MEASURES: Three response variables (antenatal care (ANC) by skilled attendants (<4 visits=inadequate vs 4 or more visits=adequate), health facility-based delivery (home vs health) and postnatal care (yes vs no) were combined to assess MHSU. Health insurance was derived from the question 'are you covered with any health insurance?' and social safety net was derived from enrolment in social safety net programmes. Logistic regression analyses were conducted, and results were reported as ORs with 95% CIs. Results of adjusted logistic regression models were fit to control for individual and community-level factors. RESULT: Prevalence of social safety net was larger than health insurance (7.7% vs 2.0%) while attendance of ANC+4, facility-based delivery and postnatal care was 48.5% (n=3760), 65.9% (n=5097) and 22.6% (n=1745) respectively, among respondents. Women were twice more likely to access maternal health services when they were covered by health insurance (adjusted OR 2.61, 95% CI 1.19 to 5.74, p<0.017) after adjusting for age at marriage, education level, wealth index, rural/urban area, parity, employment, empowerment status, exposure to media, visits and distance to health facility while no significant association of social safety net programmes with MHSU was found. CONCLUSION: Expanding access to health insurance can provide comprehensive coverage for maternal healthcare services. Social safety net programmes can be made conditional, subject to regular health checkups for mothers and children to improve maternal and child health outcomes.
Nadia Shah, Sidra Zaheer, Uzma Iram
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Early neonatal deaths, occurring within the first six days of life, remain a critical public health challenge. Understanding the trends and factors associated with this issue is crucial for designing effective interventions and achieving global health goals. This study aims to examine the trends in early neonatal mortality in Ethiopia and identify the key factors associated with changes in early neonatal mortality over time. METHODS: This study utilized five consecutive Ethiopian Demographic and Health Survey datasets from 2000 to 2019. To investigate the trends and identify factors influencing changes in early neonatal mortality over time, conducted a trend analysis and a logit-based multivariate decomposition analysis. Data management and analyses were performed using STATA version 17/MP software. All analyses were weighted to account for sampling probabilities and non-response. Statistical significance was determined at a two-sided p-value threshold of less than 0.05. RESULT: The analysis included a total of 12,260 weighted women from the 2000 survey and 5,527 weighted women from the 2019 survey. Over the study period, there was an overall downward trend in early neonatal mortality, decreasing from 34 deaths per 1000 live births in 2000 to 27 deaths per 1000 live births in 2019. The annual rate of reduction was estimated to be 1.03%. Approximately 45% of the observed decline in early neonatal mortality rate can be attributed to changes in population characteristics or endowments (E) during the study period. Factors such as the mother's age, maternal education, marital status, preceding birth interval, types of pregnancy, and the sex of the child significantly contributed to the compositional change in the early neonatal mortality rate. CONCLUSION: Over the past two decades, Ethiopia has seen a modest decline in early neonatal mortality, but this progress falls short of the Sustainable Development Goal (SDGs) targets. To achieve the SDGs, the Ministry of Health and its partners should intensify efforts to reduce early neonatal mortality. Strategies like preventing early/late pregnancies, promoting appropriate marriage timing, and prioritizing education could help further reduce early neonatal deaths. Further research is also needed to explore the factors driving this issue.
Peer-reviewed article·PubMed (US National Library of Medicine)·
A study was conducted to assess the effects of a multi-component community-based project intervention on changing knowledge of, and attitudes towards early marriage for girls in The Gambia. The study involved a cross-sectional household survey of 201 male and female parents and 296 adolescent boys and girls aged 10-19. It also included two community-based focus group discussions and six key informant interviews. The study compared the project baseline and midline data in the analysis of the survey data. The findings show a significant increase from a baseline of (44.8%) to (70.7%) at midline among the parents who have the view that the girl needs to come of age (18 years) before going into marriage. At both baseline and midline, there is a fear that girls may break their virginity by indulging in premarital sex if they do not marry early. However, there was a significant decrease from (51.7%) at baseline to (10%) (p-value <0.001) in the proportion of parents who think girls must marry early to avoid premarital sex. The findings show between (2%) and (7%) increase from baseline to midline on the view among adolescent boys and girls that girls have the right to choose who to marry. Findings from the focus group discussions and key informant interviews directly linked the changes in knowledge of attitudes towards early marriage among parents and adolescents to the project intervention.
BACKGROUND: Cancer survivors in the adolescent and young adult generation often experience marriage, pregnancy, and childbirth after treatment; thus, fertility preservation is very important. In male patients, testicular sperm extraction (TESE) is sometimes performed due to azoospermia. Such a procedure is called oncological TESE (onco-TESE). In the present study, we aimed to define onco-TESE as TESE for fertility preservation in cancer patients, including those receiving gonadotoxic treatment. METHODS: Seventeen male patients with cancer who had undergone onco-TESE for fertility preservation at Yokohama City University Medical Center between April 2014 and March 2023 were included in the study. RESULTS: Motile testicular sperm were acquired by TESE in 9 out of 17 cases. Among patients who had initiated chemotherapy before surgery, Motile sperm could be acquired by onco-TESE in 3 out of 9 cases. In chemotherapy-naive patients, Motile sperm were acquired by onco-TESE in 6 out of 8 cases. In the end, sperm cryopreservation was performed in 10 patients. Cryopreserved sperm were used in 2 of the 10 cases, and live birth was achieved after intracytoplasmic sperm injection in both cases. CONCLUSIONS: Before starting gonadotoxic treatment, it is important to confirm whether the patient desires to bear children. If having a baby is desired, a referral to a reproductive medicine doctor is recommended. Fertility preservation before starting gonadotoxic treatment is preferable, but fertility preservation could be considered even after such a treatment.
Jurii Karibe, Teppei Takeshima, Shinnosuke Kuroda et al.
This study aims to measure the level of entry into motherhood among internally displaced adolescent girls in Kaya and Kongoussi communes, Burkina Faso, and to analyze the factors associated with it. Data were collected from 404 adolescent girls aged 12-19 years in a cross-sectional survey conducted between July and August 2021. The proportion of internally displaced adolescent girls who had started childbearing was 26.5%. Age, marital status and current use of modern contraception were found to be significantly associated with entry into motherhood among internally displaced adolescent girls. Marital status mediates the effect of religion and employment on entry of the adolescents into motherhood. The results suggest that actions aimed at preventing early marriage and improving employment opportunities among adolescent girls could potentially prevent their early entry into motherhood.
Yentéma Onadja, Eric Tchouaket Nguemeleu, Drissa Sia et al.
BACKGROUND: The risk of a woman dying as a result of pregnancy or childbirth during her lifetime is about one in six in the poorest parts of the world. OBJECTIVES: The present study aims to determine prevalence of maternal risk and the influencing variables among ever-married women belonging to the reproductive age group (15-49) of Birbhum district, West Bengal. METHODS: A cohort-based retrospective cross-sectional study was carried out among the sample of 229 respondents through a purposive stratified random sampling method and a pre-designed semi-structured questionnaire. The ordinal logistic regression (OLR) model was taken as a tool of assessment. Before developing the proportional OLR model, we have checked the multicollinearity effect among the predictors and the first-order effect modifier was evaluated as well. We performed data analysis using SPSS version 26. RESULTS: The result shows that illiterate women (Odds ratios [OR] = 2.81, 95% CI, 0.277-1.791), from lower standard of living (OR = 1.14, 95% CI, -0.845-1.116), married before the age of 15 years (OR = 21.96, 95% CI, -0.55-6.73) and between the age of 15-18 years (OR = 24.51. 95% CI, -0.45-6.85) are more likely to be affected by the higher concentration of maternal risk. Other important predictor is the time of pregnancy registration. Considering the transport and related en-route causalities, the result portraying a clear picture where the distance and travel time becoming significant factors in determining the concentration of maternal risk. CONCLUSION: Incidences of child marriages should be restricted. Eradicating factors influencing an individual's decision to seek care would be an essential contribution in excluding the dominant maternal risk factors.
Alokananda Ghosh, Biswaranjan Mistri
Protection
Peer-reviewed article·PubMed (US National Library of Medicine)·
In Bangladesh, the world's largest refugee settlement currently shelters approximately one million Rohingya refugees who fled Myanmar to escape military persecution. Educating a significant number of young Rohingya, roughly half of whom are female, presents a significant challenge. Despite the presence of learning centres (LCs) across refugee camps, Rohingya girls may encounter specific barriers to accessing education due to exposure to various risks, such as violence, child marriage, and trauma stemming from past military oppression. This paper investigates the association between these risk factors and Rohingya girls' likelihood of attending LCs, and how this association may vary across refugee camps. Using survey data and employing three-level multilevel logistic regression models, I find that girls are less likely to attend LCs if they are at risk of encountering sexual abuse, child marriage, and psychological distress or trauma. These factors explain considerable variation in girls' LC attendance between camps and between households. In addition to providing more schooling opportunities to Rohingya children, prioritising girls' safety, protecting them from forced and child marriage, and supporting their psychological well-being require increased policy attention.
Mobarak Hossain
DevelopmentProtectionBD
(opens in a new tab)
Mahfuz Al Mamun, Sultan Mahmud, Jannatul Ferdous Antu et al.
