Determinants of household decision making autonomy among rural married women based on Ethiopian demography health survey: a multilevel analysis.

INTRODUCTION: Decisions made at the household level have great impact on the welfare of the individual, the local community, as well as the welfare of the nation. Women's independent decision on reproductive health increases women's access to health information and utilization of reproductive services. This has great impact on maternal and child health outcomes. However, women in developing or low-income countries often have limited autonomy and control over their household decisions. Therefore the main purpose of this research project is to investigate the potential determinants of rural women's household decision making autonomy. METHODS: A multi level analysis was performed using the fourth Ethiopian Demographic and Health Survey (EDHS) 2016 data set. A weighted sample of 8,565 married rural women was included in the final analysis. Women were considered to be autonomous if they made decisions alone or jointly with their husband in all three household decision components. It was dichotomized as yes = 1 and no = 0. Multico linearity and chi-square tests were checked and variables which did not fulfill the assumptions were excluded from the analysis. Four models were fitted. Variables with p-value ≤ 0.25 in the bi-variable multilevel logistic regression were included in the multivariable multilevel logistic regression. The Adjusted Odds Ratio (AOR) with a 95% confidence interval (95% CI) was computed. Variables with a P-value of less than 0.05 in the multi-variable multilevel logistic regression were declared as statistically significant predictors. RESULT: A total of 8,565 weighted participants involved. From the total respondents, 68.55% (CI: 67.5%, 69.5%) of women had decision making autonomy. wealth index (poor: AOR: 0.84; 95% CI: 0.72, 0.97 and middle: AOR: 0.85; 95% CI 0.73, 0.98), literacy (illiterate: AOR: 0.75; 95% CI: 0.66, 0.86), respondents working status (Not working; AOR 0.68; 95% CI; 0.60, 0.76) ,who decides on marriage (parents: AOR 0.76; 95% CI; 0.67, 0.87), and proportion of early marriage in the community (high proportion of early marriage AOR: 1.35; 95% CI; 1.10, 1.72). CONCLUSION: Women decision making autonomy was significantly determined by women economic participation (their wealth and their working status), women's literacy, proportion of early marriage in the community and women's involvement in decision of their marriage. Improving women's economic participation and enhancing women's participation to decide on their marriage will enhance women's decision making autonomy.

Sociodemographic factors underlying lifetime fertility among ever-married Swazi women.

Fertility rates remain high in certain subgroups of the population, and there is limited research about the sociodemographic factors influencing fertility, particularly in Eswatini where women are often considered minors. This study aims to investigate the changes in lifetime fertility, and the associations between sociodemographic factors and lifetime fertility among ever-married women. The study used secondary cross-sectional data from the 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys (MICS), with a sample size of 2,295 and 2,351 women, respectively. The data was analysed using descriptive statistics and multivariable Poisson regression. The results showed that fertility rates decreased from 3.47 to 3.21 children between 2010 and 2014. The study found that child loss and age (25+ years) were significant factors associated with higher fertility, while delayed age at marriage and sexual debut (20+ years), at least secondary education, and being rich were strong predictors of lower fertility rates. The study recommends creating awareness about and strengthening laws to abolish early sexual debut and marriage. It also suggests empowering women through education, encouraging the use of contraceptives, and providing maternal and child health services in rural areas where fertility rates tend to be higher.

Les taux de fécondité restent élevés dans certains sous-groupes de la population, et les recherches sur les facteurs sociodémographiques influençant la fécondité sont limitées, en particulier à Eswatini où les femmes sont souvent considérées comme mineures. Cette étude vise à étudier les changements dans la fécondité au cours de la vie et les associations entre les facteurs sociodémographiques et la fécondité au cours de la vie chez les femmes déjà mariées. L'étude a utilisé des données transversales secondaires des enquêtes par grappes à indicateurs multiples (MICS) d'Eswatini de 2010 et 2014, avec un échantillon de 2 295 et 2 351 femmes, respectivement. Les données ont été analysées à l'aide de statistiques descriptives et d'une régression de Poisson multivariée. Les résultats ont montré que les taux de fécondité ont diminué de 3,47 à 3,21 enfants entre 2010 et 2014. L'étude a révélé que la perte d'enfants et l'âge (25 ans et plus) étaient des facteurs importants associés à une fécondité plus élevée, tandis qu'un âge plus tardif au mariage et aux débuts sexuels (20 ans et plus) ), au moins une éducation secondaire, et le fait d'être riche étaient de puissants prédicteurs de taux de fécondité plus faibles. L'étude recommande de sensibiliser et de renforcer les lois visant à abolir les premiers rapports sexuels et le mariage précoces. Il suggère également d'autonomiser les femmes grâce à l'éducation, d'encourager l'utilisation de contraceptifs et de fournir des services de santé maternelle et infantile dans les zones rurales où les taux de fécondité ont tendance à être plus élevés.

Marital Quality and Depressive Symptoms Among Older Hispanic Adults in the United States.

OBJECTIVES: Despite the cultural importance of marriage as a social support system and its well-established link to mental health, older Hispanic adult populations, which are the largest racial and ethnic minoritized groups, remain understudied. The current study examined how positive and negative dimensions of marital quality are associated with depressive symptoms. METHODS: Data from Hispanic adults aged 51 years and older (n = 1,012) were obtained from the 2016 and 2018 Health and Retirement Study waves. The Center for Epidemiological Studies-Depression scale (0-8 symptoms) was modeled as a function of positive and negative marital quality measures (1-4), as well as the relevant covariates. RESULTS: Results from a negative binomial regression model showed that a 1-unit change in positive and negative marital quality was associated with a 23.61% reduction and a 23.74% increase, respectively, in depressive symptoms. The interaction terms with marital quality and gender, as well as marital quality and religion, were not statistically significant. DISCUSSION: In the United States, a large percentage of older Hispanic adults are immigrants, and their extended family tends to reside in their countries of origin. As such, older Hispanic adults may have smaller social networks, and marital quality most likely represents a culturally important social support network in later life. Significant associations between depressive symptoms and marital quality among older Hispanic adults should receive more attention in family and public health policy discussions, particularly given the increasing diversity in U.S. society.

Patterns of gender inequality perception and depressive symptoms among Chinese adults: The mediating role of marital life satisfaction.

OBJECTIVES: As one of the most severe public health issues, depressive symptoms have attracted wide attention around the world. This study aims to investigate the mediating role of marital life satisfaction in the relationship between gender inequality perception and depressive symptoms. METHODS: Data were obtained from the China Family Panel Studies (CFPS) conducted in 2020. This study incorporated a total of 13,409 married residents aged 20 and above. RESULTS: The residents with middle (B = 0.19, 95 % CI = 0.01, 0.40) or high perception of gender inequality (B = 0.55, 95 % CI = 0.34, 0.75) were more likely to develop depressive symptoms. Marital life satisfaction plays a mediating effect in the relationship between patterns of gender inequality perception and depressive symptoms, and the mediating effect accounted for 4.89 % or 1.37 % of the total impact in the residents with middle or high patterns of gender inequality perception. LIMITATIONS: Further studies need to understand the mechanisms of perceived patterns of gender inequality and depressive symptoms, because the cross-sectional design in this study cannot draw causal inferences. CONCLUSION: Patterns of gender inequality perception are significantly associated with depressive symptoms. Marital life satisfaction plays a mediating role in the relationship between patterns of gender inequality perception and depressive symptoms. It is plausible that nurturing healthy marital relationships could mitigate depressive symptoms in individuals who perceive high degrees of gender disparity.

Associations of nuptiality perceptions, financial difficulties, and socio-demographic factors with mental health status in Australian adults: Analysis of the Household, Income and Labour Dynamics in Australia (HILDA) survey.

OBJECTIVE: This study examined the association of nuptial/relationship factors, financial difficulties, and socio-demographic factors with the mental health status of Australian adults. DESIGN: Cross-sectional quantitative study design. SETTINGS, PARTICIPANTS, AND INTERVENTIONS: Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey wave 19, 6846 adults were included in the analysis. Mental health was measured using the mental component summary (MCS) subscale of the Short-Form Health Survey SF-36. Hierarchical multiple linear regressions were used to examine the predictors of mental health status. RESULTS: Overall, 7.1% of the participants reported poor mental health status. Individual financial difficulty factors explained 3.2% (p<0.001) of the variance in mental health scores. In addition, financial difficulties were negatively associated with mental health status. Nuptiality and relationship factors accounted for 9.8% (p<0.001) of the variance in mental health status. CONCLUSION: The study suggests negative marital or relationship perceptions and financial difficulties are significant factors accounting for poor mental health. This finding suggests the need for more policy attention toward the social determinants of poor mental health especially nuptiality or relationship perceptions which have received less policy and research attention in Australia.

The marital and fertility sentiment orientation of Chinese women and its influencing factors - An analysis based on natural language processing.

BACKGROUND: With the evolution of China's social structure and values, there has been a shift in attitudes towards marriage and fertility, with an increasing number of women holding diverse perspectives on these matters. In order to better comprehend the fundamental reasons behind these attitude changes and to provide a basis for targeted policymaking, this study employs natural language processing techniques to analyze the discourse of Chinese women. METHODS: The study focused on analyzing 3,200 comments from Weibo, concentrating on six prominent topics linked to women's marriage and fertility. These topics were treated as research cases. The research employed natural language processing techniques, such as sentiment orientation analysis, Word2Vec, and TextRank. RESULTS: Firstly, the overall sentiment orientation of Chinese women toward marriage and fertility was largely pessimistic. Secondly, the factors contributing to this negative sentiment were categorized into four dimensions: social policies and rights protection, concerns related to parenting, values and beliefs associated with marriage and fertility, and family and societal culture. CONCLUSION: Based on these outcomes, the study proposed a range of mechanisms and pathways to enhance women's sentiment orientation towards marriage and fertility. These mechanisms encompass safeguarding women and children's rights, promoting parenting education, providing positive guidance on social media, and cultivating a diverse and inclusive social and cultural environment. The objective is to offer precise and comprehensive reference points for the formulation of policies that align more effectively with practical needs.

Evaluation of planned number of children, the well-being of the couple and associated factors in a prospective cohort in Yokohama (HAMA study): study protocol.

INTRODUCTION: Many developed countries including Japan are experiencing declining birth rates, particularly in urban areas. A gap between the planned number of children and the actual number of children exists, that is attributed to various factors such as: childcare leave and employment policies, childcare services, financial support, husbands' contributions to household chores and childcare, marriage support, community, and couples' well-being. Therefore, we propose HAMA study for having a baby, parenting, and marriage life (HAMA = 'H'aving 'A' baby, parenting, and 'MA'rriage life) in Yokohama (an urban area) to examine these issues. METHODS AND ANALYSIS: In this large-scale cohort study, we will elucidate the actual situation of families and child-rearing in Yokohama, evaluate the current policies and propose future measures to prevent a decline in the birth rate. Overall, 10 000 young married couples (wives aged 20-39 years as of 2022) will be randomly selected, and a survey form will be sent to them annually. They will be followed-up for 5 years to examine the factors associated with the planned number of children, well-being of the couple, childcare support policies, externalisation of housework and childcare, fathers' participation in housework and childcare, wives' free time, loneliness and social connectedness, relationship with the spouse and if they are working, questions regarding their work style and work-life balance will also be included. Ultimately, a conceptual model of the planned number of children and associated factors will be developed. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of Yokohama City University (reference number: 2022-10) and will be conducted following appropriate ethical guidelines. Opportunities to withdraw consent to participate in the survey are provided to participants. The results of this survey will be published as research papers in relevant journals and will be reported to the administration of Yokohama city and other agencies.

Trends, patterns and predictors of high-risk fertility behaviour among Indian women: evidence from National Family Health Survey.

BACKGROUND: Numerous studies have demonstrated that high-risk fertility behaviour (HRFB), which includes maternal age below 18 or above 34 years, short birth intervals (less than 24 months), and high parity (birth order above 4), is associated with adverse maternal and child health outcomes. There is a substantial research gap in the domain of high-risk fertility behaviour in the Indian context. Therefore, this study is designed to investigate the current trends and patterns in the prevalence of high-risk births among Indian women, with a primary focus on identifying contributing factors associated with this prevalence. METHODS: The study utilized data from the nationally representative National Family Health Survey (NFHS), which has been conducted in five rounds since 1992-93. Data from all rounds were used to assess the overall trend. However, data from the most recent round of NFHS, conducted during 2019-21, were employed to evaluate current levels and patterns of HRFB prevalence and to identify socio-economic and demographic predictors of HRFB using binomial and multinomial logistic regression models. RESULTS: The prevalence of HRFB has exhibited a consistent decreasing pattern from 1992 to 93 to 2019-21 in India. However, 29.56% of married women continue to experience high-risk births with notably higher rates in several states (e.g., 49.85% in Meghalaya and 46.41% in Bihar). Furthermore, socio-demographic factors like wealth index, educational level, social group, religion, mass media exposure, family size, age at marriage, type and region of residence, and reproductive factors like birth intention, place and type of delivery, ANC visits and current contraceptive use were identified as significant predictors of high-risk births among women in India. CONCLUSION: Despite a 20.4 percentage point decline in HRFB prevalence over the past three decades, a significant proportion of women in specific regions and demographic subgroups continue to experience high-risk births. Therefore, the present study recommends interventions aimed at preventing high-risk births among women in India, with particular emphasis on states with high HRFB prevalence and women from socioeconomically disadvantaged backgrounds.

Do couples who play together stay together? A longitudinal dyadic examination of shared leisure, financial distress, and relationship outcomes.

We examined whether shared leisure offers protection against negative associations between financial distress and relationship quality (satisfaction and commitment) for lower- and higher-income couples. We expected husbands' and wives' reports of shared leisure would be protective of the effects of financial distress (Time 2) on relationship satisfaction (Time 3) and commitment (Time 4) for higher-income couples (but not lower-income couples). Participants were drawn from a nationally representative, longitudinal study of US newly married couples. The analytic sample included both members of 1382 different-gender couples with data across the three sampled waves of data collection. Shared leisure was largely protective of the effects of financial distress on husbands' commitment for higher-income couples. For lower-income couples, higher shared leisure exacerbated this effect. These effects were only found at extreme levels of household income and shared leisure. When considering if couples who play together stay together, our findings suggest that it can, but it is critical to understand the financial situation of the couple and the resources they may have to support shared leisure activities. Professionals working with couples should consider their financial situation when making recommendation to engage in shared leisure, such as going out for recreation.

Which Came First, the Money or the Sex? Bidirectional, Indirect Associations between Financial Management Behaviors and Sexual Satisfaction among Newlywed Couples.

Scholars have established connections between how married couples navigate their finances and their sexual relationship. For example, financial management behaviors are associated with sexual satisfaction among newlywed couples. However, we know very little about the direction of the association between financial management behaviors and sexual satisfaction. Understanding which might predict the other, or if there might be a bidirectional association between the two, could provide information on where to intervene to help newlywed couples with financial or sexual obstacles in their marriage. With three waves of dyadic data (N = 1,205 U.S. newlywed couples), we used structural equation modeling to examine the bidirectional, indirect associations between husbands' and wives' financial management behaviors and their own sexual satisfaction through their own marital satisfaction. Overall, we found that financial management behaviors indirectly predicted changes in sexual satisfaction through marital satisfaction for both husbands and wives. We also found limited evidence that husbands' sexual satisfaction indirectly predicted changes in their own financial management behaviors through their own marital satisfaction. Additionally, these indirect associations differed by gender. Partner effects, however, were largely non-significant. Implications of these findings for those who help newlywed couples with their sexual relationships are discussed.

For richer, for poorer: Financial behaviors, power (im)balance, and relational aggression among different-gender newlyweds in the U.S.

Guided by an intersectional feminism framework, we used three-wave, dyadic survey data from a nationally representative sample of 1625 U.S. different-gender newlywed couples to test three research questions. First, as balanced power is considered a key concept for relational well-being in feminism, we examined developmental trajectories in husbands' and wives' perception of power (im)balance. Second, considering money as a major influence on power and aggression, we examined how financial behaviors relate to power (im)balance and in turn relational aggression-a type of intimate partner violence that is controlling and manipulative in nature. Third, informed by the intersectionality between gender and socioeconomic status (SES), we examined gender differences and SES disparities in the associations among financial behaviors, developmental trajectories of perception of power (im)balance, and relational aggression. Our findings demonstrate that newlywed different-gender couples are experiencing power struggles, where two partners diminish each other's influence over time. We also found that healthy financial behaviors are associated with balanced power and, in turn, less relational aggression (especially for wives and in lower-SES households). Taken collectively, we continue calling for efforts to facilitate money management skills and promote balanced marital power.

Men's household water fetching in India: Gender inequity is associated with greater responsibility and related risks.

INTRODUCTION: Household water fetching elevates physical and emotional harms, and these are generally assumed to accrue to women due to gendered labor assignments. But even in cases like India where fetching remains a highly feminized task, there are households where the primary responsibility is assumed by men. METHODS: We test the proposition that men's responsibility for water fetching is predicted by greater gender equity, reflected in measures of wives' empowerment. We used an extremely large, nationally representative Demographic and Health Survey dataset from India (2019-2020), narrowed to only households in which spouses co-reside with off-plot water sources (N = 10 616), and applying a multinomial regression approach. RESULTS: In >20% of households, men are the primary fetchers. They are more likely to have primary responsibility when water is more distant, privately purchased, or transported by vehicle. Contrary to predictions, men assume greater responsibility for household water fetching as their wives' empowerment measures decrease and when they want to control their movement. CONCLUSION: Married men in India sometimes assume responsibility for water fetching, but this is not explained by greater household gender equity. The findings also suggest that when men are responsible for fetching they have heightened risk of some forms of physical trauma but less relative psychological harm. Detailing why men fetch water matters for identifying and mitigating the physical and emotion harms of bearing responsibility for water labor, with implications for how gender should be conceptualized in water interventions intending to improve health and well-being.

Economics of widowhood mortality in adult women in India.

The economic consequence of widowhood on health is well-established, demonstrating that economic factors can significantly link with health outcomes, even the risk of mortality for widows. However, empirical evidence is restricted only to developed countries. Thus, this study assesses the role of economic factors (paid work, pension and household economic status) on the mortality of widows in broad age groups in India. We used two waves of the India Human Development Survey (IHDS), a nationally representative prospective dataset in India for 42,009 women (married and widows) aged 25 years and above at IHDS wave 1 whose survival status was observed between two waves. Further, 6,953 widows were considered for sub-sample analysis in this study. Logistic regression and propensity score matching (PSM) were applied to understand the association and causality between economic factors and mortality for widows. Poor household economic status, paid regular work, and receiving a widowed pension were significantly associated with lower mortality risk for young widows. In comparison, unpaid and paid regular work was linked with lower mortality risk for old widows. The result of causal analysis suggests that receiving a widows' pension had a slight impact on mortality reduction for young widows while engaging in paid regular work significantly reduced the mortality of old widows. This research confirms that the link between economic factors and mortality among widows is age dependent in the Indian context.

State and sex-specific trends in the annual incidence of child marriage in the United States since the year 2000.

OBJECTIVES: Child marriage, defined as marriage before 18 years of age, is a violation of human rights with harmful consequences for population health, educational attainment, and economic opportunities. Child marriage is legal across most of the United States but how often it happens is challenging to estimate. We measured state and sex-specific trends in the annual incidence of child marriage in 41 states and the District of Columbia. METHODS: We collected data from marriage certificates filed between 2000 and 2019. These certificates allowed us to identify marriages that occurred within each state and involved a spouse under the age of 18. We divided the number of 15-17-year-olds married in each year by the number of children in that age range living in the state in that year and graphed these annual rates to present trends over time. RESULTS: The rate of child marriage declined substantially across the United States between 2000 and 2019. Over 75 % of all married children in each state were girls. Girls married men who were an average of 4 years older than they were, and the age gap was substantially larger when girls married than when boys married. CONCLUSIONS: Child marriage continues across most of the United States and reflects gender inequities in American society. The continued legality of marriage before the age of 18 is at odds with the country's commitment to eliminate child marriage by the year 2030 and violates the human rights of children, primarily girls, across the country.

Money management over the course of marriage: Parenthood, employment and household financial organization in Japan.

In Japan, differentiated gender expectations are strongly emphasized and Japanese wives shoulder the majority of the domestic work. Although previous research has examined the gendered division of paid and unpaid work in Japan, much less attention has been paid to household money management patterns among Japanese couples. Traditionally, Japanese women do the household financial organization, regardless of their employment status. Husbands transfer all of their income and other earnings to their wives and receive a monthly allowance as pocket money. We use data from the Japanese Panel Survey of Consumers (JPSC), 1994-2019 waves, to construct fixed-effect models to investigate how parenthood, wife's employment and husband's relative income are associated with different money management systems in Japan. Our findings show that parenthood is positively associated with female money management systems, whereas in dual-earner couples, women are less likely to manage household money. The results suggest that female money management in Japan is positioned as part of the package of wife / mother / homemaker roles and is a "female" task rather than "male". The results also show that the applicability of Western money management typologies and theoretical frameworks is limited for the Japanese context.

Trends in child marriage, sexual violence, early sexual intercourse and the challenges for policy interventions to meet the sustainable development goals.

INTRODUCTION: Child marriage remains a prevalent issue in low- and middle-income countries (LMIC) despite global declines. Girls are disproportionately affected, facing health risks, limited education, and restricted decision-making power. We aim to provide insights for child marriage prevalence across LMIC from 1990 to 2020, with a focus on sexual violence and early sexual intercourse for public health policy interventions. METHODS: This study used World Bank datasets to assess progress in addressing child marriage in LMIC countries. Statistical analyses, including trend analysis and compound annual growth rate (CAGR), were conducted to evaluate indicators of first marriage, sexual violence, and sexual intercourse. Countries with sufficient data were categorized based on prevalence rates and trends, and detailed analysis focused on significant indicators. RESULTS: While significant reductions were observed in the prevalence of child marriage before the age of 15 and 18 and early sexual intercourse in most countries, few countries show increasing trends, and others could not demonstrate statistical trends due to data limitations, such as scarcity of data for boys. Overall, many countries showed a decline in sexual violence and early sexual intercourse before the age of 15, but some exhibited increasing trends. For instance, Zambia and Senegal showed a decreasing trend of sexual violence, while Nigeria exhibited an increasing trend. Notably, Uganda, Cameroon, and Sierra Leone for women, and Namibia, Zambia, and Kenya for men, experienced substantial decline in early sexual intercourse. CONCLUSION: There is a decline in child marriage, sexual violence, and early sexual intercourse in most countries independent from the income group. Only a few countries show slight increasing trends. The improvements confirm that policies that address education, employment, and deep-rooted gender inequality at the societal level seem to be effective and help reach the SDG. However, better data are needed to enhance the understanding of the development of child marriage in these countries to improve the effectiveness of policy intervention. Therefore, we recommend that policymakers not only include existing evidence that continues progress but also increase and improve the monitoring of relevant indicators.

Child marriage remains a prevalent issue despite global declines, particularly affecting girls who suffer from health risks, lower education, and restricted decision-making power. However, little is known about boys in this context. This study aims to examine We aim to provide insights for child marriage prevalence across LMIC from 1990 to 2020, with a focus on sexual violence and early sexual intercourse for public health policy interventions. To achieve this, we assessed progress in addressing child marriage in LMIC countries using World Bank datasets. Through statistical analyses, including trend analysis and linear regression, we evaluated various indicators. Countries with sufficient data were categorized based on prevalence and trends. The results revealed significant reductions in all indicators, few countries show increasing trends, and others could not demonstrate statistical trends due to data limitations, such as scarcity of data for boys. The Central African Republic experienced an increase in child marriage prevalence. Overall, many countries showed a decline in sexual violence and intercourse before the age of 15, but some exhibited increasing trends. For instance, Zambia and Senegal showed a decreasing trend of sexual violence, while Nigeria exhibits an increasing trend. Notably, Uganda, Cameroon, and Sierra Leone experienced substantial declines in early sexual intercourse for women, and Namibia, Zambia, and Kenya for men. There is a decline in child marriage, sexual violence, and early sexual intercourse in most countries independent of the income group. Only a few countries show slight increasing trends. The improvements confirm that policies that address education, employment, and deep-rooted gender inequality at societal level seem to be effective and help reach the SDG. However, better data are needed to enhance the understanding of the development of child marriage in these countries to improve the effectiveness of policy intervention. Therefore, we recommend that policymakers not only include existing evidence that continues progress but also increase and improve the monitoring of relevant indicators.

Qualitative endline results of the tipping point project to prevent child, early and forced marriage in Nepal.

Currently, Nepal is not on track to meet Sustainable Development Goal 5.3 - the elimination of harmful practices, including child, early and forced marriage by the year 2030. Evidence on what works to prevent child, early and forced marriage often is inattentive to contextual factors that influence intervention effectiveness. This study presents qualitative results of a mixed-methods evaluation of CARE's Tipping Point Program to prevent child, early and forced marriage in Nepal, interrogating the perceived benefits of the programme and elucidating contextual features that enhance or detract from programme benefit. Baseline data included interviews with adolescent girls (N = 20), boys (N = 10), adult community leaders (N = 8) and focus group discussions (FGDs) with girls (N = 8 groups; 48 individuals), boys (N = 8 groups; 47 individuals) and parents (N = 16 groups; 95 individuals). Using thematic analysis and structured comparisons by time, gender, district, caste/community, stakeholder type and arm, we found diverse programme participation, but widespread improvements in knowledge across several domains, with behavioural changes concentrated among participants with stronger participation and pre-programme characteristics suggestive of low risk of child marriage. Findings underscore the need to address structural barriers to prevent child marriage and the challenges of attributing programme benefit amidst a dynamic social context.

Prevalence, trends, and determinants of contraception use among women in Nigeria: An analysis of Nigeria demographic and health surveys 2008 to 2018.

Within Africa, maternal mortality remains a concern that can be prevented and addressed. Among the various African countries, Nigeria has one of the highest mortality rates, particularly in a context where the population continues to rise. The relationship between contraceptive usage among married Nigerian women and low socioeconomic development contributes to another concerning public health issue- performing unskilled abortions. This cross-sectional study examines how seven (7) key social determinants of health impact the usage of contraceptive methods among Nigerian women ages 15-24. Data were analyzed and acquired from the Nigerian Demographic and Health Survey (NDHS) and the National Population Commission (NPC) in 2008, 2013, and 2018. Bivariate and multivariable logistic regression analyses illustrate social determinants have a deep effect on access and usage of contraceptives in Nigeria. Results yielded that as factors such as age, education, and socioeconomic status increase, the use of contraceptives increases as well. While autonomy has little to no significance, religion and urbanity present challenges to Nigerian women who are interested in using contraceptives. More so, this study suggests a stronger need for education for Nigerian women at an early age and deepening the understanding of the barriers to contraception use with the help of the community and religious leaders.

En Afrique, la mortalité maternelle reste une préoccupation qui peut être évitée et traitée. Parmi les différents pays africains, le Nigeria présente l'un des taux de mortalité les plus élevés, notamment dans un contexte où la population ne cesse d'augmenter. La relation entre l'utilisation de contraceptifs chez les femmes nigérianes mariées et le faible développement socio-économique contribue à un autre problème de santé publique préoccupant : la pratique d'avortements non qualifiés. Cette étude transversale examine l'impact de sept (7) déterminants sociaux clés de la santé sur l'utilisation des méthodes contraceptives chez les femmes nigérianes âgées de 15 à 24 ans. Les données ont été analysées et acquises à partir de l'Enquête démographique et de santé nigériane (NDHS) et de la Commission nationale de la population (NPC) en 2008, 2013 et 2018. Les analyses de régression logistique bivariées et multivariées illustrent que les déterminants sociaux ont un effet profond sur l'accès et l'utilisation des contraceptifs. au Nigéria. Les résultats ont montré qu'à mesure que des facteurs tels que l'âge, l'éducation et le statut socio-économique augmentent, l'utilisation de contraceptifs augmente également. Même si l'autonomie n'a que peu ou pas de signification, la religion et l'urbanité présentent des défis pour les femmes nigérianes qui souhaitent utiliser des contraceptifs. Plus encore, cette étude suggère un besoin plus fort d'éducation des femmes nigérianes dès leur plus jeune âge et d'approfondir la compréhension des obstacles à l'utilisation de la contraception avec l'aide de la communauté et des chefs religieux.

Development and validation of the Economic Coercion Scale-20 (ECS-20): A short-form of the ECS-36.

The Economic Coercion Scale 36 (ECS-36) is a validated scale measuring women's exposure to economic coercion for low-income countries. A valid short form is needed to facilitate parsimonious measurement of economic coercion in general surveys or program evaluations. We used data from a probability sample of 930 married women 15-49 years in Matlab, Bangladesh. We selected 21 items from the ECS-36 based on theory, content coverage, and item and dimensional information. We evaluated external validity with measures of non-economic intimate partner violence and depressive symptoms. We tested measurement invariance of the short-form scale across participants and non-participants of microfinance programs. A final, 20-item scale captured husband's interference with wife's (1) acquisition of economic resources and (2) use or maintenance of economic resources. IRT results of the ECS-20 demonstrated precision over the higher range of the economic coercion trait. Tests of external validity confirmed expected correlations of the ECS-20 with measures of IPV and depressive symptoms. The ECS-20 was measurement invariant across groups of women who did and did not participate in microfinance programs. The ECS-20, a valid short-form of the ECS-36, is suitable for general surveys and monitoring potential adverse impacts of microfinance programs targeting women.