Students and brides: a qualitative analysis of the relationship between girls' education and early marriage in Ethiopia and India.

BACKGROUND: Early marriage (< 18 years) is associated with education cessation among girls. Little research has qualitatively assessed how girls build resiliency in affected contexts. This study examines these issues in Oromia, Ethiopia and Jharkhand, India among girls and their decision-makers exposed to early marriage prevention programs. METHODS: Qualitative interviews were conducted with girls who received the intervention programs and subsequently either a) married prior to age 18 or b) cancelled/postponed their proposed early marriage. Girls also selected up to three marital decision-makers for inclusion in the study. Participants (N = 207) were asked about the value and enablers of, and barriers to, girls' education and the interplay of these themes with marriage, as part of a larger in-depth interview on early marriage. Interviews were transcribed, coded, and analyzed using latent content analysis. RESULTS: Participants recognized the benefits of girls' education, including increased self-efficacy and life skills for girls and opportunity for economic development. A girl's capacity and desire for education, as well as her self-efficacy to demand it, were key psychological assets supporting school retention. Social support from parents and teachers was also important, as was social support from in-laws and husbands to continue school subsequent to marriage. Post-marriage education was nonetheless viewed as difficult, particularly subsequent to childbirth. Other noted barriers to girls' education included social norms against girls' education and for early marriage, financial barriers, and poor value of education. CONCLUSION: Social norms of early marriage, financial burden of school fees, and minimal opportunity for girls beyond marriage affect girls' education. Nonetheless, some girls manifest psychological resiliency in these settings and, with support from parents and teachers, are able to stay in school and delay marriage. Unfortunately, girls less academically inclined, and those who do marry early, are less supported by family and existing programs to remain in school; programmatic efforts should be expanded to include educational support for married and childbearing girls as well as options for women and girls beyond marriage.

Beyond the statistic: exploring the process of early marriage decision-making using qualitative findings from Ethiopia and India.

BACKGROUND: Early marriage of girls (marriage < 18 years) is a pervasive abuse of rights that compromises maternal and child health. The common conceptualization of this practice as an outcome undermines the nuanced and sometimes protracted decision-making process of whom and when to marry. METHODS: This paper uses qualitative data from semi-structured interviews with females aged 13-23 years who participated in child marriage prevention programs and either married early or cancelled/postponed early marriage, and their key marital decision-makers in Oromia, Ethiopia (n = 105) and Jharkhand, India (n = 100). RESULTS: Social norms and the loss of a parent were stressors sustaining early marriage across contexts. Participants described three stages of early marriage: initiation, negotiation and final decision-making. Girls were infrequently involved in the initiation of early marriage proposals, though their decision-making autonomy was greater in groom-initiated proposals. The negotiation phase was most open to extra-familial influences such as early marriage prevention program staff and teachers. Across settings, fathers were the most important final decision-makers. CONCLUSIONS: The breadth and number of individual and social influences involved in marital decision-making in these settings means that effective early marriage prevention efforts must involve girls, families and communities. While underlying norms need to be addressed, programs should also engage and enable the choice, voice and agency of girls. Empowerment was important in this sample, but generally required additional social resources and support to have impact. Girls with greater social vulnerability, such as those without a male caretaker, had more compromised voice, choice and agency with regards to early marriage. Understanding early marriage decision-making as a process, rather than an endpoint, will better equip programs and policies that aim to eliminate early marriage to address the underlying norms that perpetuate this practice, and is an important lens through which to support the health and human rights of women and girls globally.

Intersections of girl child marriage and family planning beliefs and use: qualitative findings from Ethiopia and India.

Child marriage and subsequent early first birth is a considerable social, economic and health concern, and a pervasive practice in sub-Saharan Africa and South Asia. This study explores barriers and facilitators to family planning among women and girls, and their marital decision-makers subsequent to receipt of child marriage prevention programmes in Ethiopia and India. In-depth interviews with 128 women and girls who were married as minors or who cancelled or postponed marriage as minors and their marital decision-makers were analysed using content analysis. Respondents identified social norms, including child marriage and pressure to have children, and lack of information as barriers to family planning. Benefits included delayed first birth and increased birth spacing, improved maternal and child health and girls' educational attainment. Respondents associated family planning use with delayed pregnancy and increased educational attainment, particularly in Ethiopia. Child marriage prevention programmes were identified as important sources of family planning information. Ethiopia's school-based programme strengthened access to health workers and contraception more so than India's community-based programme. Findings highlight young wives' vulnerability with regard to reproductive control, and support the need for multi-sector approaches across communities, schools and community health workers to improve family planning among young wives.

Process evaluation of the SHARE intervention for preventing intimate partner violence and HIV infection in Rakai, Uganda.

The Safe Homes And Respect for Everyone (SHARE) intervention introduced an intimate partner violence (IPV) prevention approach into Rakai Health Sciences Program, an established HIV research and service organization in Uganda. A trial found exposure to SHARE was associated with reductions in IPV and HIV incidence. This mixed methods process evaluation was conducted between August 2007 and December 2009, with people living in SHARE intervention clusters, to assess awareness about/participation in SHARE, motivators and barriers to involvement, and perceptions of how SHARE contributed to behavior change. Surveys were conducted with 1407 Rakai Community Cohort Study participants. Qualitative interviews were conducted with 20 key informants. Most (77%) were aware of SHARE, among whom 73% participated in intervention activities. Two-thirds of those who participated in SHARE felt it influenced behavior change related to IPV. While some felt confident to take part in new IPV-focused activities of a well-established program, others were suspicious of SHARE's motivations, implying awareness raising is critical. Many activities appealed to the majority (e.g., community drama) while interest in some activities was limited to men (e.g., film shows), suggesting multiple intervention components is ideal for wide-reaching programming. The SHARE model offers a promising, acceptable approach for integrating IPV prevention into HIV and other established health programs in sub-Saharan Africa.

Perceptions of Adolescent Pregnancy Among Teenage Girls in Rakai, Uganda.

The leading causes of death and disability among Ugandan female adolescents aged 15 to 19 years are pregnancy complications, unsafe abortions, and childbirth. Despite these statistics, our understanding of how girls perceive adolescent pregnancy is limited. This qualitative study explored the social and contextual factors shaping the perceptions of adolescent pregnancy and childbirth among a sample of 12 currently pregnant and 14 never pregnant girls living in the rural Rakai District of Uganda. Interviews were conducted to elicit perceived risk factors for pregnancy, associated community attitudes, and personal opinions on adolescent pregnancy. Findings indicate that notions of adolescent pregnancy are primarily influenced by perceptions of control over getting pregnant and readiness for childbearing. Premarital pregnancy was perceived as negative whereas postmarital pregnancy was regarded as positive. Greater understanding of the individual and contextual factors influencing perceptions can aid in development of salient, culturally appropriate policies and programs to mitigate unintended adolescent pregnancies.