Parenting experiences of marriage immigrant women in South Korea during the COVID-19 pandemic: a descriptive phenomenological study.

PURPOSE: This study aimed to investigate the experiential meaning of child-rearing for marriage immigrant women in Korea in the context of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Using the hermeneutic descriptive phenomenology framework developed by Colaizzi, 10 marriage immigrant women rearing preschool and school-age children were invited through purposive and snowball sampling from two multicultural support centers in Korea. The participants were rearing one or two children, and their original nationalities were Vietnamese, Japanese, Cambodian, and Chinese. Individual in-depth, face-to-face, semi-structured interviews were conducted from September 1 to November 30, 2021. We extracted significant statements from the transcripts, transformed these into abstract formulations, and organized them into theme clusters and themes to authentically capture the essence of the participants' subjective experiences. RESULTS: Four theme clusters with 14 themes were derived. The four theme clusters identified were "navigating child healthcare alone," "guilt for not providing a social experience," "worry about media-dependent parenting," and "feelings of incompleteness and exclusion." This study explored the perspectives of mothers raising children as marriage migrant women who experienced physical and emotional health crises due to the COVID-19 pandemic. CONCLUSION: The findings underscore that marriage immigrant women encountered heightened challenges in managing their children's health and well-being during the COVID-19 pandemic due to linguistic and cultural barriers limiting access to healthcare and information. Additionally, these women experienced considerable emotional stress from perceived inadequacies in providing a holistic social and developmental environment for their children under extensive social restrictions.

Illuminating health aspects for immigrant Thai women in Swedish transnational marriages.

BACKGROUND: Women who are migrants experience discrimination and face major risks, including sexual exploitation, trafficking, and violence, which affect their health and well-being. This study explored critical health incidents experienced by immigrant Thai women in marriage migration. METHODS: A qualitative explorative approach with in-depth interviews was used. Forty immigrant Thai women who currently or previously had a Swedish spouse were recruited for the study. An inductive critical incident technique was used to collect and analyze the data as the first step. In a second deductive step, the Newman system model was used to categorize health dilemmas. RESULTS: The women reported 438 critical health incidents in five main areas. Psychological health dilemmas included emotional abuse, feeling overwhelmed due to family responsibilities and the stress of leaving family behind. Sociocultural health dilemmas included transnational family duties or not performing family duties. Physiological health dilemmas included experiencing physical violence and environmental, domestic or work accidents. Developmental health dilemmas included failing health, difficulties upholding the duties expected of a spouse in the target culture and caring for an elderly husband. Spiritual health dilemmas included critical incidents in which the women perceived themselves to have failed in their hopes and duties as a wife, which intensified their dependence on faith, particularly the Buddhist concept of karma. CONCLUSION: Professionals in health and welfare practices in Thailand together with professionals in Western countries who work with women in marriage migration situations need to recognize the psychological, sociocultural, physiological, developmental, and spiritual health dilemmas experienced by these women. Furthermore, civil organizations that meet Thai women in foreign countries, such as Buddhist cultural associations, would benefit from the multicultural knowledge revealed by the present study. This knowledge can facilitate healthcare and welfare support for women in marriage migration situations.

Views of Intermarried Couples: Implications for Social Work Practice.

Intermarriage, defined here as the marriage between people of different races or different ethnicities, is on the rise in the United States, with one in six newlyweds intermarrying. While public opinion approval of interracial marriage is at an all-time high, racial and ethnic hate crimes are also on the rise, which can affect spouses differently based on their identity. Drawing on a 2022 Qualtrics sample of 287 spouses who intermarried and have children, authors of this article sought to learn what is related to their holding a positive view of intermarriage. Talking openly with one's spouse about differences, children initiating discussions about race, and being consciously aware of the interracial or interethnic aspect of the marriage were predictors. Implications for social work practice, which are predicated on the ability to have open communication between family members and the social worker's comfort with their own racial identity, are included for this growing population of intermarried couples.

Childhood and Midlife Cultural Awareness and Activity Engagement Among Korean Married Couples.

OBJECTIVES: Cultural reproduction theory posits that cultural resources are transmitted across generations, suggesting early parental influences on cultural experiences in adulthood. Further, cultural resources may be transferred within the same generation-through significant others, such as spouses. This study investigates cultural engagement among middle-aged adults, focusing on individual and spousal influences of childhood cultural engagement. METHODS: A sample of 1,271 couples (age 49-66) from the 2012 Korean Baby Boomer Panel Study and the Korean Forgotten Generation Study was analyzed. Each respondent reported the number of arts and cultural activities (e.g., paintings, literature, and classical music) and levels of perceived cultural engagement (i.e., cultural awareness) during childhood and at midlife. Actor-partner interdependence models (APIMs) were estimated to examine how spouses' childhood and midlife cultural engagement were linked within couples. RESULTS: Findings showed that wives reported higher levels of activity participation and cultural awareness in childhood and midlife, compared to husbands. The APIM results indicated that beyond one's own childhood cultural engagement, spouse's childhood cultural awareness was associated with both levels of participation in arts and cultural activities (only for husbands) and cultural awareness (for both husbands and wives) at midlife. DISCUSSION: Cultural activities and awareness can be valuable assets to enhance overall well-being in later life. Given the cross-spousal associations in cultural engagement among Korean middle-aged couples, both spouses' cultural resources need to be considered for the design of interventions and policies to cultivate cultural competence and promote cultural engagement in adulthood.

Predictors of change in relationship satisfaction among Black postpartum mothers.

The transition to parenthood can be a challenging time for the relationships of new parents and result in declines in relationship satisfaction. Although a robust literature has identified characteristics that predict changes in relationship satisfaction during this period, the relationships of Black mothers postpartum remain understudied. To address this gap, we examined a set of relational, individual, and external characteristics as predictors of relationship satisfaction trajectories over the first four months postpartum. First-time Black mothers (N = 93, 22.6% married, 52.7% cohabiting, 24.7% not cohabiting) reported on relational, individual, and external characteristics at 1 week postpartum and their relationship satisfaction at 1, 8, and 16 weeks postpartum. Mothers who reported more commitment and partner support were higher in initial satisfaction, as were mothers who were married or cohabiting with a partner (relative to mothers who were not cohabiting with their partner). Mothers with clinically significant depressive symptoms at 1 week postpartum had lower initial relationship satisfaction than mothers without clinically significant depressive symptoms. Mothers' sleep difficulties and experiences of racial discrimination were associated with changes in relationship satisfaction over time; mothers experiencing more sleep difficulties and racial discrimination experienced larger declines in satisfaction. These findings offer new insights into risk and protective factors associated with relationship satisfaction among Black mothers during the early postpartum period and can inform multicomponent interventions to enhance their relationship functioning.

"One man, one life, one marriage": A qualitative analysis of Hmong women's divorce experiences.

Despite the rising divorce rates in some immigrant communities in the US, there has been scant scholarly attention on how immigrants experience divorce, particularly on the role of culture in the divorce process. The primary goal of the present study was to explore the diverse divorce experiences of Hmong immigrants in the United States. As a patrilineal and patriarchal community, divorce is generally frowned upon, with Hmong women often experiencing shame and stigma. A narrative design with nine Hmong women was used to capture their intricate stories that highlight such experiences. Using a thematic analysis, our findings highlighted the complexity and cultural nuances the women in our sample encountered from initiating divorce to the divorce itself: (1) No wants a divorce, (2) Divorce is the "last straw", (3) Varying divorce pathways, and (4) Navigating systems as a Hmong woman. For those who have increased knowledge of both the US American court system and divorce laws along with the traditional Hmong mediations, they may be more equipped in navigating systems. Yet as Hmong divorce practices are performed by Hmong men, Hmong women may struggle with finding their voice or support needed to advocate for their divorce. In such cases, the US court system may be more appealing in assisting their cause (e.g., custody). Professionals working with such communities should be culturally aware and attuned to the different marriage and divorce practices to understand both cultural and legal barriers for those seeking a divorce.

Arranged cohabitation among Chinese Muslims.

While modern family-related ideas and behaviors have become more widely accepted in contemporary China, Chinese Muslim minorities continue to hold on to traditional religious practices. Surprisingly, data from our survey conducted in Gansu province in China's northwestern borderlands reveal that Muslims of the Hui and Dongxiang ethnicities reported much higher rates of cohabitation experience than the secular majority Han. Based on follow-up qualitative interviews, we found the answer to lie in the interplay between the highly interventionist Chinese state and the robust cultural resilience of local Islamic communities. While the state maintains a high minimum legal age of marriage, the early marriage norm remains strong in Chinese Muslim communities, where religion constitutes an alternative and often more powerful source of legitimacy-at least in the private sphere of life. Using the 2000 census data, we further show that women in almost all 10 Muslim ethnic groups have higher percentages of underage births and premarital births than Han women, both nationally and in the northwest where most Chinese Muslims live. As the once-outlawed behavior of cohabitation became more socially acceptable during the reform and opening-up era, young Muslim Chinese often found themselves in "arranged cohabitations" as de facto marriages formed at younger-than-legal ages. In doing so, Chinese Muslim communities have reinvented the meaning of cohabitation. Rather than liberal intimate relationship based on individual autonomy, cohabitation has served as a coping strategy by which Islamic patriarchs circumvent the Chinese state's aggressive regulations aimed at "modernizing" the Muslim family.

Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa.

BACKGROUND: Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators. METHODS: We analyzed national household surveys from 37 countries in SSA, conducted during 1990-2018, to examine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15-24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban-rural residence and educational status (primary or less versus secondary or higher education). RESULTS: In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000-2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10-14 years). Large differences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban-rural and wealth-related inequalities remained stagnant or widened during 2000-2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories. CONCLUSION: Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress.

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.

Kinship, Connective Care, and Disability in Jordan.

Temporalities of care shape the lives of families raising children with Down syndrome in Jordan. As they age, parents grapple with the future's uncertainties and often circle back to questions of marriage. Marriage is a key symbol of adulthood, shaping futures and actualities of care by distributing gendered and generational labor among kin. Over time, children with Down syndrome depart from the normative trajectories embedded in these kinship- and marriage-based systems of care, leaving them stuck. While parents worry about care futures, they and their grown children contend with constricting opportunities in the present.

Determinants of Sexual Violence Against Married Women: Qualitative Evidence From Ghana.

Some evidence suggests that in sub-Saharan Africa, sexual violence is commonplace among married women, yet this problem is underresearched. Using qualitative methods and applying Heise's social-ecological model, this study examined the experiences of 15 Ghanaian women suffering sexual violence in their marriages. Results from the thematic analysis indicate several determinants of sexual violence. Whereas some participants identified macro-level and exosystem factors, including poverty, others pointed to micro-level and ontogenic factors, such as husbands' substance abuse. The results corroborate the core idea of Heise's framework, namely, that structural- and individual-level factors make women vulnerable to violence. The study concludes that Ghanaian legal and policy frameworks must be enforced and strengthened to address the etiology of sexual violence and abuse.

The roles of women empowerment on attitude for safer sex negotiation among Indonesian married women.

The situation of low women empowerment in household settings might influence women's attitude and ability to negotiate for protected sex in their marital relationship. This study aimed to investigate the association between women empowerment factors and the attitude for safer sex negotiation among Indonesian married women. The secondary data of 28,934 individual records of married women retrieved from the 2017 Indonesia Demographic and Health Survey (IDHS) was used. The dependent variable was the attitude for safer sex negotiation measured by women's acceptance toward a justification to ask her husband to use a condom if her husband has a sexually transmitted disease. Multivariate logistic regression analysis accounting for the complex survey design was performed. The results showed that women empowerment factors, that include higher level of education and participation in household decision-making had a positive effect on women's attitude for protected sex. Those women with higher levels of HIV knowledge and whoever talked about HIV with their husbands were also more likely to justify for protected sex. Therefore, women empowerment through education, improving socioeconomic conditions, and increasing HIV-related knowledge can help develop a positive attitude and enable women to negotiate for safer sex with their partners.

The tradition of markobar in mangalap boru “Picking a Bride” as advice for the women mental health in mandailing wedding ceremony

Objective: The study was conducted to explain the role of markobar (speech) in mangalap boru toward the bride (specifically) and women (generally) mental health in Mandailingnese. This study is concerned with explaining the phenomenon of using language used to console and strengthen the bride who will move into the groom's house. Methods: This study used the ethnography model. The data were taken using a recording, interview, and observation. The steps in markobar of mangalap boru were analyzed based on its structure and explaining the speech that consists of advice for the bride. Results: Markobar in mangalap boru produced the utterances to advise the bride to face her new situation with her groom's big family. The speech consists of an introduction by telling the steps of knowing the bride. It was then continued by a speech of accepting the bride to the grooms’ big family and advice from both sides. It is covered by giving speeches of the bride's family's requests to take care of their daughter and promise from the groom's family. Conclusion: Tradition markobar in mangalap boru affected the bride's mental health to release her life custom with her family and move forward with her new husband. The advice pieces in markobar strengthen her spirit and mental to accept the new situation and adapt it sincerely. The language used and performance in delivering markobar is Mandailing local wisdom that should be maintained toward an agreed life system in Mandailingnese. (AU)

The association between consanguineous marriage and offspring with congenital hearing loss.

BACKGROUND: Consanguinity is a commonly recognized practice among marriages in the Middle East and may lead to an increase in the prevalence of inherited disorders. Autosomal recessive deafness is the most common form of inherited congenital hearing loss (CHL). OBJECTIVES: Determine the association of consanguineous marriages with congenital sensorineural hearing loss (SNHL) and auditory neuropathy. DESIGN: Descriptive and analytical cross-sectional study. SETTING: Ear specialist hospital. PATIENTS AND METHODS: Children with severe-to-profound congenital SNHL, who had been referred to the specialist hospital for cochlear implant were analyzed. Patients were divided into subgroups based on degree of consanguinity. MAIN OUTCOME MEASURE: The relative risk of having more than one child with SNHL in offspring of a consanguineous marriage. SAMPLE SIZE: 189 parents and children with CHL. RESULTS: The parents of 157 children (83.1%) were blood-related. Of those, 48 had more than one child with CHL (31.4%), while only two parents who were not blood-related had more than one child with CHL (6.25%; P=.005). Among the 189 children, 131 (69.3%) parents were direct cousins. Only 39 (20.6%) and 43 (22.8%) children had family histories of CHL on the paternal and maternal sides, respectively. There was no statistically significant difference in the prevalence of auditory neuropathy between the offspring of consanguineous and non-consanguineous marriages (P=.648). CONCLUSION: The risk of having more than one child with SNHL in the offspring from a consanguineous marriage is 3.5 times higher than that of a non-consanguineous mating. LIMITATION: The association of hearing loss degree with consanguinity was not studied. CONFLICT OF INTEREST: None.

Mujeres, naturaleza y cultura: una lectura ecofeminista de la cultura matrilineal de las tribus khasis, jaintia y garo de Meghalaya / Tribus khasis, jaintia y garo de MeghalayaWomen, Nature and Culture: An Ecofeminist Reading of the Matrilineal Culture of the Khasis, Jaintia and Garo Tribes of Meghalaya / Mulheres, Natureza e Cultura: Uma Leitura Ecofeminista da Cultura Matrilineal das Tribos Khasis, Jaintia e Garo de Meghalaya

El noreste de la India, la tierra de los habitantes originales, sigue una cultura y tradición únicas y fascinantes, ya que sus habitantes están estrechamente vinculados a la naturaleza. El noreste de la India es uno de esos pocos lugares en el mundo donde todavía se practica la cultura matrilineal. En Meghalaya, uno de los estados del noreste, la práctica de la matrilinealidad existe desde hace casi 2000 años entre algunas tribus. Khasi, Jaintia y Garo, las primeras comunidades étnicas de Meghalaya parecen ser homogéneas, ya que la hija menor se convierte en la custodia de las perspectivas ancestrales. Esta práctica en la que las mujeres se convierten en custodias de los artefactos culturales y naturales tiene fuertes paralelos en la teoría del ecofeminismo. Al emplear una perspectiva ecofeminista para leer la cultura matrilineal de las tribus, el documento tiene como objetivo hacer un estudio paralelo sobre la afinidad de las mujeres étnicas con la naturaleza. El ecofeminismo celebra la sólida conexión entre las mujeres y la naturaleza y afirma que las mujeres sirven como defensoras de la naturaleza en lugar de los hombres. Por lo tanto, el documento tiene como objetivo investigar los elementos ecofeministas entre las tribus Khasi, Jaintia y Garo de Meghalaya y trata de expresar una visión ecofeminista sobre la familia, el matrimonio, la religión y la cultura alimentaria de las tribus Meghalaya

Northeast India, the land of original inhabitants, follows a unique and fascinating culture and tradition as its inhabitants are closely attached to nature. Northeast India is one of those few places in the world, where matrilineal culture is still practiced. In Meghalaya, one of the northeastern states, the practice of matrilineality has been in existence for almost 2000 years among a few tribes. Khasi, Jaintia and Garo, the earliest ethnic communities of Meghalaya appear to be homogenous ones, as the youngest daughter becomes the custodian of the ancestral prospects. This practice where the womenfolk become the custodians of the cultural and natural artifacts has strong parallels in the theory of ecofeminism. By employing ecofeministic perspective to read the matrilineal culture of the tribes, the paper aims to make a parallel study on the ethnic women's affinity towards nature. Ecofeminism celebrates the robust connect between women and nature and asserts that women serve as the advocates for nature rather than men. The paper, therefore, aims to investigate ecofeministic elements among the Khasi, Jaintia and Garo tribes of Meghalaya and tries to express an ecofeministic view concerning family, marriage, religion, and food culture of the Meghalaya tribes

O Nordeste da Índia, a terra dos habitantes originais, segue uma cultura e tradição únicas e fascinantes, pois seus habitantes estão intimamente ligados à natureza. O Nordeste da Índia é um dos poucos lugares do mundo onde a cultura matrilinear ainda é praticada. Em Meghalaya, um dos estados do Nordeste, a prática da matrilinearidade já existe há quase 2.000 anos entre algumas tribos. Khasi, Jaintia e Garo, as primeiras comunidades étnicas de Meghalaya, parecem ser homogêneas, pois a filha mais nova se torna a guardiã das perspectivas ancestrais. Essa prática em que as mulheres se tornam guardiãs dos artefatos culturais e naturais tem fortes paralelos na teoria do ecofeminismo. Ao empregar a perspectiva ecofeminista para ler a cultura matrilinear das tribos, o artigo tem como objetivo fazer um estudo paralelo sobre a afinidade das mulheres étnicas com a natureza. O ecofeminismo celebra a conexão robusta entre as mulheres e a natureza e afirma que as mulheres atuam como defensoras da natureza ao invés dos homens. O artigo, portanto, tem como objetivo investigar elementos ecofeminísticos entre as tribos Khasi, Jaintia e Garo de Meghalaya e tenta expressar uma visão ecofeminista sobre família, casamento, religião e cultura alimentar das tribos Meghalaya

Marriage and Union Formation in the United States: Recent Trends Across Racial Groups and Economic Backgrounds.

Family formation in the United States has changed dramatically: marriage has become less common, nonmarital cohabitation has become more common, and racial and economic inequalities in these experiences have increased. We provide insights into recent U.S. trends by presenting cohort estimates for people born between 1970 and 1997, who began forming unions between 1985 and 2015. Using Panel Study of Income Dynamics data, we find that typical ages at marriage and union formation increased faster across these recent cohorts than across cohorts born between 1940 and 1969. As fewer people married at young ages, more cohabited, but the substitution was incomplete. We project steep declines in the probability of ever marrying, declines that are larger among Black people than White people. We provide novel information on the intergenerational nature of family inequalities by measuring parental income, wealth, education, and occupational prestige. Marriage declines are particularly steep among people from low-income backgrounds. Black people are overrepresented in this low-income group because of discrimination and opportunity denial. However, marriage declines are larger among Black people than White people across parental incomes. Further, most racial differences in marriage occur among people from similar socioeconomic backgrounds. Family inequalities increasingly reflect both economic inequalities and broader racial inequalities generated by racist structures; in turn, family inequalities may prolong these other inequalities across generations.

Premarital Counseling Practices among Christian and Muslim Lay Counselors in Ghana.

We examined premarital counseling services offered by Christian and Muslim lay counselors in Ghana. Participants including clergy, Islamic clerics, and laity practicing in four urban centers were interviewed. Thematic analysis showed that common issues covered include medical screening, beliefs and values, expectations, partner knowledge, roles and duties, sex, parenthood, financial management, communication, and conflicts. The findings offer important insight into religious premarital counseling in Ghana and contribute to the global literature on premarital counseling.

"It is what I tell her that she will do": a mixed methods study of married men's knowledge and attitude towards supporting their wives' cervical cancer screening in rural South-East Nigeria.

INTRODUCTION: cervical cancer is a leading cause of death among Nigerian women. Women often require spousal support before attending cervical cancer screening services. This study assessed married men´s knowledge and attitude towards male involvement in cervical cancer screening of their wives. METHODS: a cross-sectional study using a mixed methods approach was conducted among 245 married men in Izzi, Local Government Area of Ebonyi State, South-East Nigeria. Quantitative data collected using structured, interviewer-administered questionnaires and qualitative data from focus group discussions were triangulated. Data analysis was done using IBM SPSS version 20. Qualitative findings were analysed using thematic analysis. RESULTS: the mean knowledge of cervical cancer was 2.06±0.55. Only 2.9% of the respondents had adequate knowledge of risk factors for cervical cancer. Up to 89.8% were willing to approve screening for their spouses. Majority (76.3%) considered screening important in cervical cancer prevention, while 91.4% were willing to pay for the screening test. Most of them exhibited patriarchal tendencies and insisted that their wives must obtain their consent before screening as depicted by the statement "It is what I tell her that she will do". Previous spousal screening was a predictor of good knowledge (OR = 10.94, 95% CI = 2.44-48.93; P=0.002). CONCLUSION: married men in this study had poor knowledge of cervical cancer. However, they were willing to support cervical cancer screening conditional on their pre-information and consent. Awareness creation activities on cervical cancer screening should incorporate active engagement of husbands in order to promote screening uptake by their wives.

Understanding individual, family and community perspectives on delaying early birth among adolescent girls: findings from a formative evaluation in rural Bangladesh.

BACKGROUND: Pregnancy among adolescent girls in Bangladesh is high, with 66% of women under the age of 18 reporting a first birth; this issue is particularly acute in the northern region of Bangladesh, an area that is especially impoverished and where girls are at heightened risk. Using formative research, CARE USA examined the underlying social, individual and structural factors influencing married girls' early first birth and participation in alternative opportunities (such as education or economic pursuits) in Bangladesh. METHODS: In July of 2017, researchers conducted in-depth interviews of community members in two sub-districts of northern Bangladesh (Kurigram Sadar and Rajarhat). Participants (n = 127) included adolescent girls (both married and unmarredi), husbands of adolescent girls, influential adults in the girls' lives, community leaders, and health providers. All interviews were transcribed, coded and organized using Dedoose software. RESULTS: Participants recognize the health benefits of delaying first birth, but stigma around infertility and contraceptive use, pressure from mothers-in-law and health provider bias interfere with a girl's ability to delay childbearing. Girls' social isolation, lack of mobility or autonomy, and inability to envision alternatives to early motherhood compound the issue; provider bias may also prevent access to methods. While participants agree that pursuit of education and economic opportunities are important, better futures for girls do not necessarily supersede their marital obligations of childrearing and domestic chores. CONCLUSIONS: Findings indicate the need for a multi-level approach to delaying early birth and stimulating girls' participation in economic and educational pursuits. Interventions must mitigate barriers to reproductive health care; train adolescent girls on viable economic activities; and provide educational opportunities for girls. Effective programs should also address contextual issues by including immediate members of the girls' families, particularly the husband and mother-in-law.