Menarcheal age and subsequent patterns of family formation.

We examine whether age at menarche affects age at first marriage or first birth using two samples of U.S. women. Data are drawn from the Tremin Trust, a longitudinal study of menstrual cycles that recruited white women who were students at the University of Minnesota and from a survey of a nationally representative sample of white women born between 1900 and 1910. Regression models with cubic splines were used to analyze the relationship between age at menarche and age at first marriage. Cox proportional hazard models were used to examine the effect of age at menarche on the interval between marriage and first birth. Unlike earlier work, we found that once secular trends in both age at marriage and age at menarche were taken into account, there was no evidence that age at menarche affects either age at marriage or the timing of first births in these U.S. women.

Credit programs, patriarchy and men's violence against women in rural Bangladesh.

Although violence by men against women in Bangladesh occurs in most cases within the home, in a larger sense it does not originate in the home nor persist only within the home. It is simply one element in a system that subordinates women through social norms that define women's place and guide their conduct. This paper uses ethnographic and structured survey data from a study in rural Bangladesh to explore the relationship between domestic violence against women and their economic and social dependence. It describes some of the common situations in which violence against women occurs in Bangladeshi society, analyzes its larger context, and identifies factors that appear to lessen its incidence in this particular socio-economic setting. The study findings suggest that group-based credit programs can reduce men's violence against women by making women's lives more public. The problem of men's violence against women is deeply rooted, however, and the authors argue that much more extensive interventions will be needed to significantly undermine it.

Program- and method-related determinants of first DMPA use duration in rural Bangladesh.

This article examines the determinants of first-time use durations of the injectable contraceptive Depo Medroxy Progesterone Acetate (DMPA) for rural Bangladeshi women. The method's side effects were defined by 200 first-time users in Matlab district during lengthy, open-ended interviews. Women with many children used the method longer than did women of low parity. Those who experienced side effects had shorter use durations than those who did not, and those who cited heavy bleeding as their main problem discontinued use soonest. Women whose husbands approved of family planning had significantly longer use durations than those whose husbands disapproved. Respondents who adopted DMPA because of perceived positive aspects of the drug used it longer than those who chose it for other reasons. Results of the study underscore the importance of viewing side effects in a specific social and cultural context. Expanded side-effects counseling for women and their husbands is needed.

PIP: During March-May 1990, in-depth interviews were conducted with 200 women who first accepted the injectable contraceptive depo-medroxyprogesterone acetate (DMPA) between July and August 1988 from the Maternal and Child Health and Family Planning program of the International Centre for Diarrhoeal Disease Research, Bangladesh in the rural Matlab district. The researchers analyzed the data to examine the determinants of first-time use durations of DMPA. 90% of the women chose DMPA because of negative experiences or fears of such experiences with other methods. Women who reported bleeding and nonbleeding side effects were more likely to have shorter use durations than those who reported no side effects (rate ratio [RR] = 1.83 and 3.07, respectively). Women who had heavy bleeding had the shortest use duration (median, 9 vs. 20 months for no problems). Amenorrhea was rarely considered to be the most significant problem linked to DMPA use. Women who chose DMPA because of its perceived positive aspects were more likely to have longer use duration than those who did not choose it for its positive aspects (RR = 0.38). Women who chose DMPA based on the community health worker's advise were more likely to have shorter use durations than those who did not choose it based on their advice (RR = 2.48). Women whose husbands approved of family planning were more likely to have longer use duration than those whose husbands did not approve (RR = 0.72). Multiparous women used DMPA longer than did those with less than 3 children (RR = 0.56 for 3-5 children and 0.36 for =or 6 children). These findings emphasize the importance of considering side effects in a social and cultural context to determine why they are important to women and which side effects are perceived as problematic and which are not. They also show the need to improve pre-use counseling and side effect management and to seek the support of husbands towards family planning.

Determinants of adolescent fertility and its consequences for maternal health, with special reference to rural Bangladesh.

The second section of this paper set forth a theoretical model relating adolescent growth and development to family formation patterns and their implications for maternal and child health. Subsequent sections of the paper examine the evidence to support specific relationships hypothesized in the model, focusing on longitudinal data from Matlab, Bangladesh. Despite the emphasis on developing country populations, literature from developed countries was also reviewed. The weight of the evidence suggests that in the developed countries, while there is a positive relationship between reproductive maturation and subsequent reproductive behavior, the negative effects of young maternal age on pregnancy outcome is confounded with socioeconomic factors. Teenage pregnancy, or at least teenage birth, occurs disproportionately among the socially and economically disadvantaged. Moreover, teenage childbearing in the U.S., especially when it occurs outside of marriage, violates social norms, at least in the white population. Poor diet may be a problem in the U.S. but it does not appear to result in notable delays in physical growth and development, delayed or compromised adolescent growth, or late age at menarche. Limited evidence suggests that early menarche may be associated with more rapid onset of mature menstrual cycle activity but these findings have not been replicated elsewhere. In developing countries the situation is quite different. First, early marriage and childbearing are desired and common across most segments of society. Second, malnutrition is widespread, and is sufficiently severe to delay the adolescent growth spurt and raise average age at menarche by two to three years compared with developed country populations. This is certainly the case in Bangladesh. In this setting, several observations regarding the relationship of nutritional status, adolescent development and reproduction have been made. First, undernutrition delays growth and reproductive maturation, and women who mature early (i.e., women with young age at menarche) marry at younger ages than later maturers. In addition, body weight appears to have an independent effect on age at marriage, net of age at menarche, such that relatively heavy women marry at younger ages than their lighter counterparts. Explanations for this finding include correlation between body weight and development of secondary sex characteristics, and perhaps a cultural perception that heavier (i.e., normal body weight) women are more attractive, or healthier, mates. The effect of menarche and nutritional status on marriage gives rise to concern that an improvement in nutritional status, and an increase in the age at menarche, would lead to younger marriage and first birth, and higher lifetime fertility.(ABSTRACT TRUNCATED AT 400 WORDS)

Age at menarche and postmenarcheal growth in rural Bangladeshi females.

This study examines the role of chronological age and time since menarche (TSM) as determinants of postmenarcheal growth in height and weight in a chronically malnourished population of rural Bangladeshi females aged 10-20 years. Height and weight measurements were collected for 12 months from 290 postmenarcheal girls, with known times since menarche, and on 118 girls who reached menarche during the one year follow-up. Two stage regression analysis was employed to study the relationship of age and time since menarche to postmenarcheal growth in height and weight, while adjusting for socioeconomic status. TSM is a more important determinant of postmenarcheal growth in height and weight than is age. For postmenarcheal growth in weight, the regression coefficient for TSM is six times greater then the coefficient for age. The effect of TSM was twice as strong as the age effect for postmenarcheal growth in height. Age has a statistically significant negative influence on statural growth and weight gain, but its practical effect on weight gain is small. An interaction between TSM and age suggests that TSM does not have the same implications for biological maturity for all ages at menarche. Findings demonstrate that Bangladeshi adolescents are still in active growth in height and weight into their late teens and past 20 years in some girls. This extended growth period may pose increased health risks to young mothers and their offspring.