Predictors for the change in intimate partner violence among adolescent married girls aged 15-19 years: Estimates from random effect model.

BACKGROUND: Intimate Partner Violence (IPV) is one of the most common forms of violence against women. IPV against adolescents and young adult married women (15-19 years only) is poorly understood and not much researched as compared to their adult counterparts. The present study investigates the changes in multiple forms of IPV and tries to understand its association with different individual factors. METHODS: The study used longitudinal data from Understanding the lives of Adolescent and Young Adults study (UDAYA), conducted in 2015-16 (wave 1) and 2018-19 (wave 2). The survey was done in two Indian states namely, Uttar Pradesh and Bihar. The sample size of the present study was 4,254 married adolescent girls aged 15-19 years. Multiple forms of IPV were the outcome variables of this study. A random effect regression analysis was used to estimate the association of changes in physical, sexual, and emotional violence with decision-making power and mobility restrictions along with other covariates. RESULTS: Findings show that physical and emotional violence have increased from wave 1 to wave 2. Furthermore, married adolescent girls who took decisions alone/with others were less likely to suffer from IPV (ß=-0.02; p < 0.05). Adolescent girls who agreed with the perception about wife-beating were more likely to report physical (ß = 0.07; p < 0.05), sexual (ß = 0.13; p < 0.05), and emotional violence (ß = 0.14; p < 0.05). The risk of IPV was significantly more among adolescent girls whose family paid dowry compared to those who did not pay it (ß = 0.04; p < 0.05). CONCLUSION: Interventions against those social norms that harm any female adolescents' status in society and negatively impact their educational attainment should be adopted, simultaneously, with programs that promote gender equality in all aspects of their life.

The association between early in marriage fertility pressure from in-laws' and family planning behaviors, among married adolescent girls in Bihar and Uttar Pradesh, India.

BACKGROUND: Married adolescent girls are vulnerable to risky sexual and reproductive health outcomes. We examined the association of fertility pressure from in-laws' early in marriage with contraceptive use ever, parity, time until first birth, and couple communication about family size, among married adolescent girls. METHODS: Data were taken from a cross-sectional survey with married girls aged 15-19 years (N = 4893) collected from September 2015 to July 2016 in Bihar and Uttar Pradesh, India. Multivariable regression assessed associations between in-laws' fertility pressure and each outcome, adjusting for sociodemographic covariates. RESULTS: We found that 1 in 5 girls experienced pressure from in-laws' to have a child immediately after marriage. In-laws' fertility pressure was associated with lower parity (Adj. ß Coef. - 0.10, 95% CI - 0.17, - 0.37) and couple communication about family size (AOR = 1.77, 95% CI 1.39, 2.26), but not contraceptive use or time until birth. CONCLUSIONS: Our study adds to the literature identifying that in-laws' pressure on fertility is common, affects couple communication about family size, and may be more likely for those yet to have a child, but may have little effect impeding contraceptive use in a context where such use is not normative.

"It is painful and unpleasant": experiences of sexual violence among married adolescent girls in Shinyanga, Tanzania.

BACKGROUND: While the situation of married adolescent girls in Tanzania is increasingly documented, empirical evidence concerning the ways in which child marriage impacts girls' and young women's sexual lives is limited. Specifically, little is known about lived experiences on sexual violence among married adolescent girls in Tanzania. METHODS: This article reports on a qualitative study using a phenomenological approach to describe married girls' experiences of sexual violence in the Shinyanga Region, an area with the highest prevalence (59%) of child marriage in Tanzania. Data were collected from 20 married girls aged 12-17 years. RESULTS: The study identified four analytical themes regarding the experience of sexual violence, namely: forced sex; rape; struggling against unpleasant and painful sex; and inculcation of the culture of tolerance of sexual violence. CONCLUSION: The study highlights the voices of married adolescents on an important but a neglected topic of relevance to Tanzania's public health. Findings from this study suggest that married adolescent girls suffer sexual coercion in silence. Child marriage is a major public health problem in sub-Saharan Africa in general and in Tanzania in particular. However, there is limited research on the ways in which it impacts sexual lives of married adolescent girls. In response to the inadequacy of information, married adolescent girls in Shinyanga Region of Tanzania were requested to voice out their experiences of sexual violence. Three themes were identified from the responses, namely: forced sex; rape, struggling against unpleasant and painful sex; and the inculcation of the culture of tolerance of sexual violence. In conclusion, this study has echoed voices of married adolescent girls on the sexual troubles they experience. Their main concern is that they suffer sexual coercion in silence, which increases their risk of acquiring sexually transmitted infections and/or unwanted pregnancies. Recommendations for sexual violence prevention strategies are discussed.

Family planning perspectives and practices of married adolescent girls in rural Upper Egypt.

OBJECTIVES: The aims of the study were to explore the contraceptive practices of married adolescent girls in rural Upper Egypt and identify the determinants of their ever use of modern contraception. METHODS: The study was a household survey of 729 married adolescent girls in 23 villages of two governorates in Upper Egypt. Listing and enumeration of all households in the selected villages were performed prior to data collection, to recruit married adolescent girls below 20 years of age. The girls were interviewed using a structured questionnaire. RESULTS: Only 6% of married adolescent girls were using a modern contraceptive method; 10.6% had ever used a modern contraceptive method, mostly a short-acting method. Considerable proportions of participants believed that using contraception would reduce a woman's fertility and that women should not delay their first pregnancy (34% and 54.3%, respectively); only 50.2% believed that contraception could be used for birth spacing. Predictors of the ever use of a modern method of contraception among married adolescent girls were: accepting that contraception could be used for birth spacing (B = 1.82, p < .001), older age (B = 0.42, p < .01), better reproductive health knowledge (B = 0.23, p < .05) and sharing in contraceptive decision making (B = 0.55, p < .05). CONCLUSION: Married adolescent girls' current use and ever use of modern contraception were very low in rural Upper Egypt. Changing the social norms to create the desire to delay first childbirth, improving adolescent girls' reproductive health knowledge, correcting myths about contraception and building girls' agency to use contraception may increase their contraceptive use.

Designing a guideline for empowering married adolescent girls in reproductive health: a mixed-method study protocol.

BACKGROUND: Investing in adolescent's health, especially, the role of girls in community health and future generations is one of the most important strategies of the Millennium Development Goals. In this regard, supplying adolescents' special needs including access to educational, health and counseling services for promoting reproductive health have been emphasized. About 36% of registered marriages in Iran are under the age of 19 though, reproductive health services based on married adolescent girls` needs in social-cultural context were not predicted in national health system. Therefore, this study aim was designing a guideline for empowering married adolescents in reproductive health. METHODS: This is a sequential exploratory Mixed-method study conducted in three consecutive phases. The first phase, with a qualitative approach, explores needs, barriers and strategies for empowering married adolescent girls in reproductive health. In the second phase, a systematic review will be conducted to identify the recommendation and strategies for empowering married adolescent girls in reproductive health in other countries. Finally, in third phase, data from qualitative study and systematic review are emerged and the most important solutions and recommendations related to the issue are extracted and the final guideline is adapted by the experts. DISCUSSION: This study is attempting to provide a guideline containing comprehensive recommendations for health system` policy makers and providers in order to empowering adolescent girls in reproductive health.

Partner's characteristics and adolescent motherhood among married adolescent girls in 48 low-income and middle-income countries: a population-based study.

OBJECTIVES: The objective of this study was to examine the prevalence of adolescent motherhood among married adolescent girls and its associations with their partners' characteristics in low-income and middle-income countries (LMICs). DESIGN: Population-based study. PARTICIPANTS: 54 285 ever married (or lived with a partner) adolescent girls (15-19 years old) were including in prevalence analysis. However, partner characteristics were assessed in a subsample of 24 433 adolescent girls who were married (or living with a partner) at the time of interview. SETTINGS: Data from the latest available Demographic and Health Survey round during 2010-2018 in 48 LMICs across different geographic regions. RESULTS: The overall prevalence of adolescent motherhood was 73.98% (95% CI 70.96 to 78.10) among married adolescent girls in this study. In the pooled analysis, statistically significant and positive associations were observed between adolescent motherhood and partners' desire for more children (adjusted marginal effect (AME): 2.34, 95% CI 1.21 to 3.47) and spousal age gap (AME: 1.67, 95% CI 0.30 to 3.04 for three plus age gap). However, no statistically significant association was observed between adolescent motherhood and partners' education (AME: -0.36, 95% CI -1.77 to 1.05 for primary education) and partners' agricultural occupation (AME: 1.07, 95% CI -0.17 to 2.32). Overall, there was significant variation in the associations across countries; however, the positive associations persisted between adolescent motherhood and partners' desire for more children and spousal age gap in most of the studied countries. CONCLUSIONS: Our findings may inform policymakers about the importance of incorporating partners of married adolescent girls into the existing birth control programmes to delay age at first birth among married adolescents in LMICs. More attention should be given to the married adolescent girls who have older partners, and efforts to discourage marriages with much older partners may have a secondary benefit of reducing adolescent motherhood in LMICs.

Elevating Married Adolescents' Voices for Responsive Reproductive Healthcare in Syria.

Increases in early marriage and pregnancy resulting from Syria's humanitarian crisis highlight a critical gap in adolescents' access to life-saving sexual and reproductive health information and services, and a larger need for adolescent-specific interventions grounded in gender transformative approaches. Seeking to address this, CARE, UNFPA and Syria Relief and Development adapted global evidence-based approaches to humanitarian contexts to create the Adolescent Mothers Against all Odds (AMAL) Initiative for pregnant girls and first-time mothers aged 10 to 18 years. Designed to improve the lives of young girls through responsive health systems and enabling environments, AMAL includes three components: a Young Mothers Club for first-time mothers and pregnant girls, participatory dialogues with health providers, and reflective dialogues with girls' marital family and community members. The AMAL Initiative intends to ensure responsiveness to the unique vulnerabilities of adolescent sub-groups by co-implementing with them. Select girls undergo additional leadership training and serve as adolescent representatives on community advisory groups sharing feedback for program improvement. One hundred-four first-time mothers and pregnant girls, 219 community members, and 120 health providers participated in AMAL in northwest Syria. In a mixed methods evaluation, facilitators administered monitoring tools to identify program improvements, pre-post surveys to assess outcomes, and end-line discussions to gather perceptions of impact. Girls reported a 47% overall increase in self-esteem, confidence, health-seeking capacity, and communication ability. Community support for girls' use of family planning increased by 27% and girls' equal access to services by 35%. Findings across all participant groups demonstrate decreased expectations of early marriage and increased acceptance of family planning post-marriage. Areas that participants cited for potential improvement included programming for girls/women above the age of 18 years, and additional training for health providers on long-acting contraceptive methods. These results show that participatory adolescent-centered sexual and reproductive health programming is not only feasible in crisis settings but can improve the self-efficacy of vulnerable adolescents to overcome barriers to accessing healthcare and improving well-being. The AMAL Initiative is now being scaled up through local partners in Syria and piloted in northern Nigeria.

Spousal violence and its determinants among married adolescent girls in Upper Egypt.

INTRODUCTION: In Egypt, many girls are still married before the age of 18, which is a fundamental violation of the girls' human rights. Early marriage is associated with an alarmingly elevated risk of all types of intimate partner violence that have various negative consequences. The purpose of this study was to identify the predictors of exposure to spousal violence among the early married girls in rural Upper Egypt. METHODS: A household survey was carried out and covered 23 villages in Assiut and Sohag governorates reaching to a sample of 729 married girls before the age of 20. Listing and enumeration of 4 districts was done to identify the study participants. Data was collected by personal interviews using a structured questionnaire. Bivariate and stepwise regression analyses were performed to identify the predictors of exposure to spousal violence. RESULTS: It was found that 15.2% of the study participants were exposed to physical violence while 17.8% were exposed to sexual violence and 7.3% were exposed to both types. Girls married before the age of 18 were more exposed to spousal violence. Stepwise regression analysis found that girls' acceptance to get married was a protective factor against exposure to physical (ß = - 1.07, OR 0.34) and sexual (ß = - 0.68, OR 0.51) violence. The perceived attitude of husbands and mothers-in-law about considering wife beating "a husband's right" was found to be a risk factor of exposure to physical and sexual violence. Longer duration till the first pregnancy was also associated with more exposure to sexual violence (ß = 0.04, OR 1.04). CONCLUSION: Married adolescent girls (MAGs) are highly exposed to physical and sexual violence. This is mainly due to ignoring girls' preference to postpone their marriage, cultural concepts of accepting violence against women, and low sexual satisfaction. This study shows that most determinants of spousal violence were related to culture issues. Identifying these determinants is required to combat such a crucial public health problem that has serious consequences on adolescent health.

The Effect of a Club in Making Differences in Knowledge, Attitude, and Practices on Family Planning Among Married Adolescent Girls in Urban Slums in Bangladesh.

Early marriage and childbearing have led to Bangladesh having the highest adolescent fertility rate in the Asia Pacific region. Adolescent pregnancy is correlated with pregnancy-related complications, preterm delivery, delivery of low-birth weight babies, and spousal violence. A quasi-experimental study was conducted in four urban slums (two intervention and two control areas) of Dhaka from July 2014 to August 2016 to assess the effectiveness of a married adolescent girls club (MAG club) in reducing the unmet need for family planning (FP) among married girls between the ages of 14 and 19 (n = 1601, 799 in intervention and 802 in control areas). The percentages of the targeted population using any modern method of contraception were significantly higher among respondents in the intervention areas than those in the control areas (72.6% versus 63.5%). The unmet need for FP was significantly lower among respondents in the intervention areas than that of the control areas (16.2% versus 20.7%). The MAG club was a well-received strategy to provide comprehensive information on FP, which in turn helped improve contraceptive method practices and reduced the unmet need for FP among married adolescent girls in urban slums in Bangladesh. The government could leverage its existing resources to expand the MAG Club model in rural parts of the country to achieve the targets outlined in its Adolescent Reproductive Health Strategy.