Too young to be a wife! analysis of the factors influencing child marriages and its influence on the preferred number of children among women in Zambia

Context/Background: Zambia has one of the highest rates of child marriages in the world. This study sought to establish the determinants of child marriage in rural and urban areas of Zambia, and to determine the influence of child marriage on fertility preferences of women in Zambia.Data source and methods: The study utilized data from the 2013-2014 Zambia Demographic Health Survey. Data was analysed using the Binary Logistic and Poisson regression models.Results: Timing of conception, age at first sex, region of residence, education level of respondent and their partners, and family size were significant predictors of child marriages in urban areas. In rural areas, region of residence, age at fist sex, education level of respondent and their partners, and family size had significant influence on child marriages. The study further found that women who got married below the age of 18 preferred a higher number of children.Conclusion: The study established that various factors influence child marriages in urban and rural Zambia and in turn child marriages influence the preferred number of children. The findings suggest a multipronged approach to addressing the root cause of the problem

Navigating intimate sexual partnerships in an era of HIV: dimensions of couple relationship quality and satisfaction among adults in Eswatini and linkages to HIV risk

Couple relationship functioning impacts individual health and well-being, including HIV risk, but scant research has focused on emic understandings of relationship quality in African populations. We explored relationship quality and satisfaction in Eswatini (formerly Swaziland) using data from 148 in-depth interviews (117 life-course interviews with 28 adults and 31 interviews with 29 marriage counselors and their clients) and 4 focus group discussions. Love, respect, honesty, trust, communication, sexual satisfaction, and sexual faithfulness emerged as the most salient characteristics of good relationships, with both men and women emphasising love and respect as being most important. Participants desired relationships characterised by such qualities but reported relationship threats in the areas of trust, honesty, and sexual faithfulness. The dimensions of relationship quality identified by this study are consistent with research from other contexts, suggesting cross-cultural similarities in conceptions of a good relationship. Some relationship constructs, particularly respect, may be more salient in a Swazi context

Unpacking the 2-year age-gap provision in relation to the decriminalisation of underage consensual sex in South Africa

Over the past 24 years, the South African criminal justice system has undergone major transformations in relation to sexual offences,including sexual violence against children. More recently, there have been a number of developments to certain provisions in the law relating to sexual offences involving children. In response to the Teddy Bear Clinic Court Case and Constitutional Court ruling, sexual offences legislation related to underage consensual sex amended.In this regard, the legislation now decriminalises underage consensual sexual activity between adolescent peers aged 12 - 15-year-olds. In addition, the law provides broader definitions for consensual sexual activity including decriminalising consensual sex and sexual activity between older adolescents (above age of consent for sex, i.e. 16 - 17-year-olds)and younger adolescents (below the age of consent for sex, i.e. 12 - 15-year-olds), granted that there is no more than a 2-year age gap between them. One of the reasons for decriminalising consensual sexual activities between adolescent peers was because the expanded legislation cast the net for sexual offences so wide that the effects had far-reaching harmful impacts, particularly for girls, who would then be exposed to the criminal justice system. This paper focuses on unpacking the 2-year age-gap provision in SA legislation relative to selected better-resourced countries, including the rationale and the potential implications for adolescents (outside of the 2-year age gap provisions),for researchers, service providers and policy-makers. It concludes with recommendations for law reform and further research

Love matters: exploring conceptions of love in Rwanda and Swaziland and relationship to HIV and intimate partner violence

Health risks such as intimate partner violence (IPV) and HIV infection often occur within intimate sexual relationships, yet the study of love and intimacy is largely absent from health research on African populations. This study explores how women and men in Rwanda and Swaziland understand and represent love in their intimate sexual partnerships. In Rwanda, 58 in-depth interviews with 15 couples, 12 interviews with activists, and 24 focus group discussions were carried out during formative and evaluative research of the Indashyikirwa programme, which aims to reduce IPV and support healthy couple relationships. In Swaziland, 117 in-depth, life-course interviews with 14 women and 14 men focused on understanding intimate sexual partnerships. We analysed these qualitative data thematically using a Grounded Theory approach. Participants described love as being foundational to their intimate sexual partnerships. Women and men emphasised that love is seen and expressed through actions and tangible evidence such as gifts and material support, acts of service, showing intentions for marriage, sexual faithfulness, and spending time together. Some participants expressed ambivalent narratives regarding love, gifts, and money, acknowledging that they desired partners who demonstrated love through material support while implying that true love should be untainted by desires for wealth. IPV characterised many relationships and was perceived as a threat to love, even as love was seen as a potential antidote to IPV. Careful scholarship of love is critical to better understand protective and risk factors for HIV and IPV and for interventions that seek to ameliorate these risks

Age at First Marriage and First Birth Interval in Ethiopia: Analysis of the Roles of Social and Demographic Factors

The ages at which females establish marital union and give first birth depend on and result in varying demographic features. Utilizing the Ethiopian Demographic and Health Survey Data; this study examined determinants of first birth interval. The analysis was made using Cox proportional hazard model and Kaplan Meier plot based on data collected from 10;240 ever-married women in the age group 15 to 49. The result shows that first marriage at early age; lower level of education; older marriage cohort; and residence in Amhara region significantly elongated first birth interval. It reveals that timings of marriage and first birth are partly governed by social factors and marriage practices of the society although modernization factors have roles to play. The findings indicate the importance of considering the context within which marriage and first birth take place to address reproductive health problems of women and speed-up the achievement of the targets set in the National Population Policy of Ethiopia

Islam; Polygyny and Modern Contraceptive Use in Francophone Sub-Saharan Africa

Francophone sub-Saharan African countries have among the highest fertility rates and lowest modern contraceptive prevalence rates worldwide. This analysis is intended to identify the factors driving contraceptive prevalence in this population. In addition to testing the usual correlates; we have included three other variables potentially related to lower contraceptive use in the Francophone African context: being Muslim; being in a polygynous union; and participation in crucial decision-making processes. We obtained descriptive statistics for 11 Francophone African countries with DHS data collected since 2000 for relevant variables. As expected; education; place of residence; age and number of children were significant for most countries in predicting modern contraceptive use. The final three factors yielded inconclusive results. The conventional correlates were by far the most predictive of MCPR; although women's participation deserves further analysis. These results dispel anecdotal evidence that being Muslim and in a polygynous union explain low CPR in this region

Motor Neuron Disease: The Impact of Decreased Speech Intelligibility on Marital Communication

Background: The onset of motor neuron disease (MND); a neurodegenerative disease; results in physical and communication disabilities that impinge on an individual's ability to remain functionally independent. Multiple aspects of the marital relationship are affected by the continuously changing roles and responsibilities. Communication is one of the most constructive ways of dealing with emotions that are elicited by these changes. decreased speech intelligibility; the relationship between the deteriorating speech and the couples' perception of marital communication was not statistically significant.Conclusion: Overall; the results proved that the supposition that communication between couples will invariably deteriorate as a result of progressively reduced speech intelligibility is not necessarily valid. The fundamental importance of effective communication in marriage is highlighted. It is well established that augmentative and alternative communication strategies can preserve the ability to develop and maintain intimate rewarding relationships; even in the face of profound physical disabilities. Method: This study explored the association between the deteriorating speech of persons with MND and couples' perception of marital communication. Fourteen couples participated in this non-experimental correlational research study. Data were collected over a 12-month period through the administration of objective and subjective measures.Results: Results showed that despite

Mortalité maternelle à la maternité provinciale de Kananga, République Démocratique du Congo

Objectif. Identifier les determinants de la mortalite maternelle a la maternite de l'Hopital Provincial de Kananga. Materiel et methodes. Analyse retrospective de 3024 dossiers d'hospitalisation et des registres d'accouchements; sur 3 ans dans cette institution. Le niveau d'etude des sujets; leurs statuts matrimonial et socioprofessionnel; le delai entre l'admission et la survenue du deces; les principaux facteurs de risque incriminent dans le deces; ont ete les variables d'interet. Resultats. Le taux de mortalite maternel etait de 1106 deces pour 100000 naissances vivantes. Les gestantes de moins de 20 ans (52;8); les analphabetes (44;4); et les primipares; ont represente les groupes les plus vulnerables. Les femmes mariees ont constitue 61;1de l'echantillon (p? 0;02). Les causes obstetricales indirectes ont ete les principales sources de deces (91;7; p0;001); dominees par les hemorragies postnatales (41;7). Pour 1/3 des cas; le deces etait survenu a la suite d'un accouchement (38;9); ou de complications d'un avortement Les cas referes d'autres institutions etaient plus nombreux (61;1; p0;02). Les conditions hospitalieres sont apparues; comme le facteur de risque le plus incrimine dans la survenue du deces (72;2; p0;01). Conclusion. La presente enquete a identifie la Population la plus vulnerable pour la mortalite maternelle; et ses principaux determinants. Des actions devraient etre menees dans le sens de la sensibilisation et de l'amelioration de l'infrastructure hospitaliere en vue d'atteindre les objectifs du millenaire pour le developpement

Determinants of adolescent fertility in Ethiopia

Background: Worldwide, adolescents suffer from a disproportionate share of reproductive health problem. Throughout the world, over 14 million adolescents aged 15-19 years give birth annually. The purpose of this study was to assess the level and identify proximate and other determinants of adolescent fertility in Ethiopia. Methods: Raw data collected from all part of the country using stratified cluster sampling method by the Ethiopian Demographic Health Survey 2005 (EDHS-2005) was used. After the data for adolescents aged from 15 to 19 years were extracted from the large data set, Multivariate logistic regression model was applied to identify socio-demographic and economic determinants whereas Bongaarts model was used to determine proximate determinantsfertility. Results: Of the 3,266 adolescent women, 443 (13.6%) had given birth at least once prior to the survey and 133 (4.1%) were pregnant. Of the 443 adolescents who had at least given birth, the majority (72.7%) had one child while about a quarter (23.2%) had 2 live births and the rest 1.0% gave four live births with a mean number of child ever born of 1.33±0.6. The major factors associated with adolescent fertility were age, educational status, place of residence, employment, marriage, contraceptive use and postpartum infecundability. The odds for increased adolescent fertility was significantly higher in early adolescents (AOR=7.6; 95% CI=6.0 to 9.9), had lower education(AOR=6.7; 95%CI=4.1 to10.9), among rural teens (AOR=3.6; 95%CI=1.9 to 6.9) and currently not working (AOR=1.7; 95%CI= 1.3 to 2.2) than their counterparts. The observed fertility rate of 0.52 children per woman obtained from Bongaarts model of fertility indicated about 1.98 births per woman were averted due to non-marriage, delayed marriage, contraceptive use and postpartum infecundability.Conclusion: Since adolescent fertility is felt to be a problem, concerted efforts are needed to empower adolescents to fight early marriage, promote education and encourage the utilization of family planning targeting the rural teenagers

Partager l'information sur son statut serologique VIH dans un contexte de polygamie au Senegal

Au Senegal; ou la prevalence du VIH est inferieure a 1 et la stigmatisation reste importante; 40 des unions sont polygamiques. L'objet de cet article est de decrire et analyser les motivations; les avantages et les contraintes lies au partage de l'information a propos du statut VIH + ; en explorant les particularites relatives aux situations de polygamie. Il repose sur les donnees d'une recherche qualitative par entretiens approfondis et repetes sur l'experience du traitement antiretroviral et ses effets sociaux; menee sur une periode de 10 ans aupres de personnes sous traitement et de leurs soignants. Les professionnels de sante encouragent les personnes a partager leur statut; surtout dans certaines circonstances telles que la prevention de la transmission mere-enfant; neanmoins ils sont bien conscients des risques sociaux que courent certains patients; notamment des femmes. Certains insistent; d'autres n'interviennent pas aupres de celles qui ne partagent pas avec leur conjoint; tout en soulignant leur dilemme ethique. Les entretiens retracent l'evolution des attitudes des soignants a cet egard. La majorite des femmes mariees commencent par partager leur statut VIH+ avec leur mere; attendant d'elle qu'elle atteste que la contamination n'est pas due a des comportements amoraux et qu'elle participe a la mise en place d'une strategie. Dans les foyers polygames; les femmes tentent de partager l'information avec leur conjoint; en maintenant le secret au-dela du couple. Certaines craignent la divulgation par leur conjoint aupres des coepouses; dont les attitudes peuvent etre tres diverses: des recits rapportent le rejet collectif hors du foyer dont certaines femmes ont ete victimes; l'annonce est parfois faite de maniere progressive en suivant la hierarchie des positions de chaque interlocuteur dans le foyer; une autre personne rapporte la solidarite montree par ses coepouses qui lui a permis de maintenir le secret hors du foyer. L'article montre la diversite des situations et leur caractere evolutif tant en matiere de partage du statut qu'a propos des effets sociaux de ce partage

Determinants of Extramarital Sex by Men in Tanzania: A Case Study of Mbeya Region

This paper attempts to identify some factors associated with extramarital sex by men in the Mbeya region of Tanzania using data from a survey conducted in 2003/2004. The choice of Mbeya region was prompted by the fact that it has been found by previous studies to be one of the regions with the highest HIV prevalence rate in Tanzania. Correlates of extramarital sex that were considered include current age; education; residence; age at first sexual intercourse; age at first marriage and sex before marriage. A bivariate analysis of the survey data; which comprised a sample size of 568 married men aged between 15 and 62 years revealed statistically significant association between extramarital sex with current age; education; age at first intercourse and sex before marriage. The effect of these variables was tested through a multivariate logistic regression analysis and all the four independent variables were found to be statistically significant predictors of extramarital sex in Mbeya region

Sickle cell knowledge, premarital screening and marital decisions among local government workers in Ile-Ife, Nigeria

Background: In Nigeria; as in the rest of equatorial Africa; sickle cell disease (SCD) has its highest incidence and continues to cause high morbidity and early death. The condition is a major public health problem among the black race. The aim of this survey is to determine the level of knowledge about SCD and the factors associated with its prevention among local government workers in Ile- Ife. Methods: This is a cross-sectional descriptive study of the knowledge about SCD; attitude towards premarital sickle cell screening and marital decisions among local government workers in Ile-Ife; Nigeria; using a self-administered questionnaire. Results: 69of study subjects had poor knowledge of SCD; while attitude towards premarital screening was favourable in 95of the study subjects. Knowledge and attitude were significantly better among subjects with tertiary education. There was a strong positive association between attitude towards sickle cell screening and a history of undergoing screening or partner screening. Most (86.7) of the respondents and 74.0of their partners have had sickle cell screening. One-quarter of married and engaged respondents did not know their partner's sickle cell status. One-third to two-thirds of study subjects will continue the relationship with their partner when either or both have haemoglobinopathy. Conclusion and recommendation: This study showed poor knowledge of SCD among the studied subjects. There is a need for more emphasis on health education through programmes promoting sickle cell education. In addition; the development of multifaceted patient and public health education programmes; the intensification of screening for the control of SCD by heterozygote detection; particularly during routine preplacement and premarital medical examinations; and the provision of genetic counselling to all SCD patients and carriers are vital to the identification and care of the couples at risk. These will enhance the capacity of the intending couples to make informed decisions and be aware of the consequences of such decisions. Policies are needed to ensure easily accessible community-wide sickle cell screening and premarital and genetic counselling to achieve the desired decline in new births of children with SCD

Social context of premarital fertility in rural South-Africa

A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the perceptions and attitudes towards premarital fertility and late marriage among young adults of both sexes. Two focus groups and 35 individual interviews were conducted among 17-30 year olds, randomly selected. Most interviewees perceived premarital fertility as undesirable, and a new phenomenon in a context of major social changes, in particular loss of authority of parents and increasing freedom of the youth. In contrast, late marriage was perceived as positive, by both sexes, primarily for economic reasons. Much stigma was associated with premarital fertility, from friends, institutions and families who occasionally apply mild or severe sanctions. Consequences of premarital fertility were numerous: school abandonment, economic adversity, health risks, stigmatization. In extreme cases, premarital fertility might lead to exclusion and deviant behavior. Premarital fertility was ultimately due to a lack of contraception among young women, and to refusal of abortion for religious reasons, and is associated with the risk of contracting STD's. (Afr J Reprod Health 2008; 12[2]:98-110)

Premarital fertility and HIV/AIDS in Sub-Saharan Africa

The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub-Saharan African countries. The DHS surveys provided data to compute the prevalence of premarital fertility, defined as any birth before the first marriage. The UNAIDS database provided data to compute the prevalence of HIV infection among pregnant women. Results indicate a moderate association between the prevalence of premarital fertility and the prevalence of HIV infection (correlation coefficient = 0.64, P< 0.0001), and similar geographical patterns. Compared with the average pattern, outlier countries had either high levels of premarital fertility and relatively low HIV prevalence (Liberia, Madagascar, Gabon, Congo), or high levels of HIV prevalence despite low levels of premarital fertility (Lesotho, Malawi, Zambia, Zimbabwe). The overall relationship is discussed in light of the relationships between age at marriage, permissiveness and lack of protection during intercourse and their impact on premarital fertility and HIV infection among women. (Afr J Reprod Health 2008; 12[2]:64-74)

The Influence of Marital Factors on Genital Human Papilloma Virus Infection

Aim: To study the association between marital factors and human papilloma virus (HPV) infection of the cervix. Method: The subjects were 450 randomly selected sexually active women attending the antenatal; postnatal; gynaecology and family planning clinics in the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital; Nigeria between April 2001 to May 2002. The Pap smear of these patients were examined microscopically for evidence of HPV infection. A questionnaire assessing various marital characteristics of the patients were administered. Result: Abnormal smears occurred in 245 (54.5) of the patients screened. Forty eight women (10.7) had HPV associated changes constituting 19.6of all abnormal smears. Their ages ranged between 15 and 64 years; with a mean of 26+3 years. There was a statisti-cally significant association between marital status and genital HPV infection. Conclusion: Single sexually active women are at increased risk of acquiring HPV infection of the cervix and should be the target in a sporadic or an organized cervical cancer screening programme without discriminating other sexually active women

Age at sexual debut in South Africa

It is important to understand the age at which sexual relations start in designing HIV prevention strategies. Most studies on age of sexual activity of young people provide estimated percentages of those that are sexually active in specific age groups; and tend either to not provide data for age at sexual debut; or to overlook the complexities of analysing data concerning sexual debut. This study considers the rate of entry into sexual relations in South Africa by providing the median age of women at time of first sexual relations as well as other percentiles; and analyses the hypothesis that age at sexual debut has been falling. The analysis uses data from the 1998 South African Demographic and Health Survey; including a nationally representative sample of 11 735 women; aged 15 to 49; interviewed in 1998. The analysis uses life-table techniques and multivariate analysis. About 8 of the respondents had had sex by age 15. The median age at time of first sex was approximately 18 years; and virtually all the women had had sex by age 23. There is evidence that the peak of the rate of entry into sexual relations occurs at age 18 and that younger cohorts of women are entering sexual relations at a younger age. The rate of entry into sexual relations is 14 to 20 faster for the younger cohorts; based on information given by the older respondents concerning their own behaviour at the same age. Age of entry into sexual relations of the women who participated in this study is compared to findings of demographic and health surveys in Tanzania and Zimbabwe; and rates of entry into marriage are also presented. The lag between entry into sexual relations and rate of entry into marriage is compared across countries. It appears that; whereas South Africans tend to enter into sexual relations later than Tanzanian counterparts and more or less at the same stage as Zimbabweans; their rates of entry into marriage are hugely delayed. The consequences for HIV infection control are discussed

Nuptiality and risk behaviour in Lusaka and Kampala

This analysis assesses the link between partnership status and the probability of having one or more casual non-regular sexual relationships in the past 12 months, using data from sample surveys conducted in Kampala and Lusaka in 1989/90 under the auspices of the Global Programme on AIDS. Non-regular sexual relationship was found to be much more common among individuals in relatively informal primary partnerships than among married individuals, and also more common among those with multiple primary partners than among those monogamous unions. (Afr Rep rod Health 2001; 5[1]:83-89)

The desire for children in tropical Africa: the influence of relatives on fertility decisions in Ankole; Uganda

In a survey in Ankole (Uganda) in 1985; 1664 women in samples of the three socioeconomic groups (pastoralists; cultivators and mixed farmers) were asked questions on their reproductive history; and 1029 men questions on educational and wedding costs and their expectations of help from relatives and obligations to help relatives. It is shown that the extended family system allows a great deal of mutual support; while the power of the elders allows them to influence younger married relatives to follow the pronatalist traditions of the society

The association of genital ulcer disease and HIV infection at a dermatology-STD clinic in Uganda

At Mulago Hospital in Kampala; Uganda; 270 consecutive patients at the dermatology and sexually transmitted disease (STD) clinic were enrolled in a study to evaluate the association of clinical STD syndromes and human immunodeficiency virus (HIV) infection. Female patients became sexually active earlier than male patients and were younger at marriage. Persons with a history of an STD during the preceding 5 years were more likely to be HIV infected (43pc) than those without such a history (26pc; OR 2.08; 95pc C.I. 1.17; 3.73). Examination at the time of the visit demonstrated an association between genital ulcers and HIV infection in male and female patients (OR 2.21; 95pc C.I. 1.08; 4.53; and OR 8.54; 95pc C.I. 1.45; 87.55; respectively) but no association between HIV and urethritis or vaginal discharge. The etiologic fraction for HIV infection of genital ulcers was 0.218. Men with a history of contact with prostitutes were more likely to be HIV infected than those without contact (50pc versus 28pc; p less than 0.05); but once controlled for STDs; this relationship was no longer significant. This study confirms other studies from East Africa that have shown a relationship between genital ulcers and HIV infection. This finding; in the presence of no association between other STD syndromes and HIV infection; suggests that genital ulcers may be truly associated with HIV infection rather than a marker of high-risk activities

Premarital HIV/AIDS Screening among Ugandan Rural Youth

Uganda has implemented a variety of interventions to control HIV/AIDS spread. These have included HIV screening for various reasons. However; most interventions seem to have left out the rural youths. The objective of the study was to identify the reasons for not preferring HIV screening before marriage. 50 youths were purposively selected and participated in focus group discussions regarding premarital HIV screening. Reseasons for not screening were: Not wanting to miss the beauty/spouse; lack of money to do so; fear of being killed by medical personnel; some are sure cases so they don't mind; faulty machines; suspects do not want to know; lack of knowledge about the screening procedures; leads to desparate ways of spending e.g. selling land once found positive; and commercial sex threat. It is recommeded that these reasons should be addrssed if HIV spread through unscreened marriages is to be stopped