Age at Marriage, Women's Education, and Mother and Child Outcomes in Bangladesh

孟加拉国的结婚年龄、妇女教育以及母婴结局

基本信息

批准号：
8013229
负责人：
ERICA M FIELD
金额：
$ 10.21万
依托单位：
MASSACHUSETTS INSTITUTE OF TECHNOLOGY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-25 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8013229
关键词：
10 year old AIDS/HIV problem Address Adherence Adolescence Adolescent Adolescent Health Services Adult Africa Africa South of the Sahara Age Asia Awareness Bangladesh Behavior Behavioral Birth Birth Intervals Brazil Caribbean region Caring Cause of Death Cessation of life Child Child Mortality Child health care Childbirth Communities Complex Consent Contraceptive Agents Contraceptive Usage Contraceptive methods Country Data Decision Making Demographic and Health Surveys Developing Countries Discipline of obstetrics Dominican Republic Drops Economics Education Effectiveness Egypt Elements Ethiopia Etiology Expenditure Face Family Family Planning Female Female Adolescents Fertility Rates First Births Fistula Future Government Growth Health Health Care Seeking Behavior Health Services Health Services Accessibility Health Status Healthcare Home environment Household Husband Ice Immunization Incentives Income India Infant Infant Mortality Institute of Medicine (U.S.)Intervention Kenya Knowledge Latin America Laws Lead Legal Life Link Literature Mali Marriage Marriage Ages Maternal Mortality Maternal and Child Health Medical Mental Health Methods Morbidity - disease rate Mothers National Research Council Necrosis Nepal Outcome Participant Pattern Physiological Physiology Policies Population Postnatal Care Pregnancy Pregnancy Complications Pregnant Women Prevention strategy Price Probability Qualitative Research Randomized Reproductive Health Research Research Project Grants Resources Risk Role Running Rural Savings Schools Secondary Schools Services Sexuality Source South Africa Southern Asia Spouses Stress Tanzania Time Tissues Translating UNFPA UNICEF United States United States Public Health Service Unmarried Woman Women&apos s Health Work Youth age difference aged arm checkup examination child bearing cost effective design empowerment expectation experience feeding girls health care service utilization improved meetings mortality next generation offspring older men older women pregnant pressure programs reproductive skills teenage mother theories working group young mother

10 year old AIDS/HIV problem Address Adherence Adolescence Adolescent Adolescent Health Services Adult Africa Africa South of the Sahara Age Asia Awareness Bangladesh Behavior Behavioral Birth Birth Intervals Brazil Caribbean region Caring Cause of Death Cessation of life Child Child Mortality Child health care Childbirth Communities Complex Consent Contraceptive Agents Contraceptive Usage Contraceptive methods Country Data Decision Making Demographic and Health Surveys Developing Countries Discipline of obstetrics Dominican Republic Drops Economics Education Effectiveness Egypt Elements Ethiopia Etiology Expenditure Face Family Family Planning Female Female Adolescents Fertility Rates First Births Fistula Future Government Growth Health Health Care Seeking Behavior Health Services Health Services Accessibility Health Status Healthcare Home environment Household Husband Ice Immunization Incentives Income India Infant Infant Mortality Institute of Medicine (U.S.)Intervention Kenya Knowledge Latin America Laws Lead Legal Life Link Literature Mali Marriage Marriage Ages Maternal Mortality Maternal and Child Health Medical Mental Health Methods Morbidity - disease rate Mothers National Research Council Necrosis Nepal Outcome Participant Pattern Physiological Physiology Policies Population Postnatal Care Pregnancy Pregnancy Complications Pregnant Women Prevention strategy Price Probability Qualitative Research Randomized Reproductive Health Research Research Project Grants Resources Risk Role Running Rural Savings Schools Secondary Schools Services Sexuality Source South Africa Southern Asia Spouses Stress Tanzania Time Tissues Translating UNFPA UNICEF United States United States Public Health Service Unmarried Woman Women&apos s Health Work Youth age difference aged arm checkup examination child bearing cost effective design empowerment expectation experience feeding girls health care service utilization improved meetings mortality next generation offspring older men older women pregnant pressure programs reproductive skills teenage mother theories working group young mother

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项目摘要

Female marriage age, education, income, and health B1.1 Existing evidence: early marriage and female and child health In much of the developing worid, early female marriage¿defined as marriage before the age of 18¿ remains widespread despite age of consent laws banning the practice, government and NGO efforts to curtail it, increasing educafion levels, and economic growth (National Research Council and Institute of Medicine, 2005). A recent study by UNICEF revealed that in Latin America and the Caribbean 29 percent of women were married by the fime they turned 18; in Africa, 42 percent; and in Southern Asia, 48 percent (UNICEF, 2005). Bangladesh has one of the highest rates of adolescent and child marriage in the worid: Although the legal age of marriage for females is 18, nearly 50 percent of all girls and 75 percent of rural giris are estimated to be married by age 15 (UNICEF 2006). There is substantial literature showing a correlation between eariy marriage and women's health, [and health-seeking behavior]. In general, women who marry early begin childbearing at a young age (Jensen and Thornton, 2003), and complicafions in pregnancy and delivery are a leading cause of death among giris aged 15 to 19. Maternal mortality in this group is double the rates for women in their 20s. Giris who marry as adolescents face greater health risks associated with lower age of first birth, higher fertility rates, and shorter birth spacing related to lower contraceptive use (UNICEF, 2001). About 60 percent of adolescent giris in Bangladesh are mothers by age 19, and nearly all of them married (UNICEF, 2006). The 2004 Demographic Health Survey (DHS) found that 40.7 percent become mothers between 15 and 17 years, and 19.5 percent between ages 18 and 19 (NIPORT, Mitra Associates and ORC Macro, 2005). Childbearing during adolescence, when physiology is likely to be underdeveloped, is widely believed to result in higher levels of maternal mortality and morbidity, although the degree to which age infiuences reproductive outcomes is not well established. Giris age 14 and younger are five times as likely to die from pregnancy complications and their offspring are also less likely to survive (UNFPA, 2004). The discrepancy in maternal mortality by age persists even in countries where maternal mortality is low, such as Brazil and the United States (Mathur, et al., 2003). In Bangladesh, maternal mortality and severe morbidity from childbirth is neariy twice as high and rates of postnatal care are 50 percent lower for adolescent giris compared to women ages 20 to 35. Furthermore, married women ages 15 to 19 are less likely to use modern contraceptives than married women ages 20 to 24 (Population Reference Bureau. 2006). Young mothers also have higher maternal morbidity rates, including severe complicafions, such as obstructed labor or obstetric fistula, which occur primarily among young women (UNFPA and EngenderHealth, 2003; Jarrett, 1994). Without fimely intervention obstructed labor can lead to tissue necrosis, which can result in permanent maternal morbidity, if not mortality. Data on maternal morbidity is scarce, and only available for a handful of settings. In Ethiopia, where 24 percent of women give birth by age 18, obstructed labor is the immediate cause in 46 percent of maternal deaths, and three in 1,000 pregnant women develop fistula, which is also common in Bangladesh (Populafion Reference Bureau, 2006; UNFPA, 2003; Akhter, et al., 1996). Of fundamental importance is the fact that the medical community currenfiy does not know the degree to which the well-documented relafionships between age of childbearing and reproducfive outcomes are physiological consequences of eariy childbearing. Hence, this research has important scienfific value. In addition to the physiological channels, eariy marriage may also impact health through behavioral channels. First, youth is associated with less-active health-seeking behavior and limited health information, which has a negative impact on the health status of married adolescent giris. In Bangladesh, 70 percent of pregnant giris younger than 20 receive no antenatal care and 90 percent deliver their babies at home. Their access to health information is poor: 20 percent of adolescent mothers have little knowledge of life-threatening conditions during pregnancy, and the majority (married and unmarried) have no informafion on sexuality, contraception, or sexually transmitted infecfions or HIV/AIDS (Haider, et al., 1997; Nahar, et al., 1999; Barkat, et al., 2000; Bruce and Clark, 2004). Adolescent giris' access to reproductive health care and services is also poor: In Bangladesh, the need for contraception is not met for 27 percent of mothers below age 20, compared with 10 percent among those aged 20 to 35 (NIPORT, Mitra Associates and ORC Macro, 2001). Moreover, married adolescents use contraception at much lower rates than older women. In South Asia, 9 percent of married women ages 15 to 19 use modern contraception compared to 24 percent of women ages 20 to 24. In Bangladesh, the rates are 34 percent and 47 percent, respectively (Population Reference Bureau, 2006). Lower usage may refiect lack of awareness about family planning, expectations to have the first child immediately, and more limited access to health services among adolescents. In addition, younger girls tend to marry significantly older men. Research in sub-Saharan Africa found that the husbands of giris ages 15 to 19 years are on average 10 years older (UNICEF 2001). Mean spouse age difference is decreasing with women's age at first marriage throughout the worid. In West Africa, the mean spouse age difference is 12 years for girls aged 14 to 15 at first marriage, and 8 years for women married at 24 to 25 years; the same pattern is found in Southern Asia (UNFPA 2004). The presence of a large age gap between spouses can contribute to poor outcomes in a number of ways. First, older husbands tend to be more sexually experienced, which implies greater risk of sexually transmitted infecfion (Clark, 2004; Luke and Kurz, 2002). The age gap is also associated with lack of agency in marriage for the adolescent giri, which may contribute to poor health outcomes. Lack of decision-making power may translate into lower reproducfive control, or capacity to negofiate sexual relations, contracepfion, and childbearing. Qualitative research also suggests that most young married giris face pressure to get pregnant eariy in marriage and lack reproductive control to avoid it (Bledsoe and Cohen, 1993; Mensch, Bruce, and Greene, 1998; Bruce and Clark, 2004). There is qualitative but little rigorous analysis suggesfing that isolation, restricted mobility, and lack of control over household resources are more common among young married giris (Mensch, et al., 1998). Isolation and the increased stress of adult responsibilifies may have a direct detrimental impact on psychological health. Lack of mobility is also likely to contribute to low healthcare utilization among married adolescent giris. Research in India has documented that married adolescent giris' healthcare decisions are mostly controlled by husbands and mothers-in-law (Barua and Kurz, 2001). Taken together with restricted mobility, this may limit the ability of adolescent giris to access health services for themselves and their children. Finally, the negafive associafion between eariy marriage and health extends to the next generation. Children born to women under age 20 have higher infant mortality rates (IMR) through the age of five. In Mali, the Infant mortality rate is 181 per 1,000 for children of mothers under 20 compared to 111 per 1,000 for children of mothers aged 20 to 29. Similariy, these rates are 164 and 88 in Tanzania, 108 and 68 in Nepal, and 71 and 28 in the Dominican Republic (Marthur, Green, and Malhotra, 2003). In Bangladesh, the IMR is 86 for infants born to mother under 20 compared to 60 for mothers aged 20 to 29 (NIPORT, Mitra Associates and ORC Macro, 2005). Child mortality rates (CMR) are also higher for children of adolescent mothers. In Kenya, the rate is 48 per 1,000 for children born to mothers under 20 compared to 32 for children born to mothers aged 20 to 29. Comparable figures are 90 and 83 in Ethiopia; 40 and 19 in South Africa; and 15 and 13 in Egypt (Marthur, Green, and Malhotra, 2003). In Bangladesh, the CMR is 106 per 1,000 for children of mothers under 20 compared to 84 for children born to mothers aged 20 to 29 (NIPORT, Mitra Associates and ORC Macro, 2005). [How much of this correlation is due to lower utilization of health care (e.g., lower immunization rates) or less knowledge of good health practices by mothers on the part of children is unclear.]

女性婚姻年龄，教育，收入和健康 B1.1现有证据：早婚以及女性和儿童健康在发展中的大部分野蛮人中，早期的女性婚姻定义为18岁以前的婚姻仍然是宽度的目的地同意法律的年龄，禁止了实践，政府和非政府组织减少教育水平和经济增长的努力（国家研究委员会和医学研究所，2005年）。联合国儿童基金会最近的一项研究表明，在拉丁美洲和加勒比海地区，有29％的妇女因18岁结婚。在非洲，42％；在南亚，有48％（联合国儿童基金会，2005年）。孟加拉国在战争中的青少年和童婚率最高：尽管女性的合法婚姻年龄为18岁，但估计在15岁时已婚，所有女孩中的近50％和75％的乡村少女（Giris）估计已结婚（联合国儿童基金会2006年）。有大量的文献显示出简单的婚姻与妇女健康和[寻求健康的行为]之间的相关性。通常，早在年轻时开始生育早期生育的妇女（Jensen和Thornton，2003年），怀孕和分娩的并发症是15至19岁的Giris的主要死亡原因。该组的孕产妇死亡是20多岁的女性的两倍。与青少年结婚的Giris面临更大的健康风险，与较低的第一出生年龄，更高的生育率以及与降低避孕药的使用相关的较短的出生间隔（联合国儿童基金会，2001年）。到19岁时，孟加拉国约60％的青春期giris是母亲，几乎所有人都结婚了（联合国儿童基金会，2006年）。 2004年的人口健康调查（DHS）发现，有40.7％的母亲在15至17岁之间，在18至19岁之间成为19.5％的母亲（Niport，Mitra Associates和Orc Macro，2005年）。在青少年期间的生育，当生理学不发育不足时，人们被广泛认为会导致较高的孕产妇死亡率和发病率，尽管年龄及其生殖结果的程度尚未得到很好的确定。 14岁的Giris和Young死于妊娠并发症的可能性五倍，其后代也较小生存的可能性也较小（Hudpa，2004年）。即使在主要死亡率较低的国家，例如巴西和美国，孕产妇死亡率的差异仍然存在（Mathur等，2003）。在孟加拉国，与20至20至35岁的妇女相比，青少年Giris的产妇死亡率和严重的发病率近两倍，而产后护理的发生率则低50％。此外，15至19岁的已婚妇女使用的现代避孕药的可能性少于20至24岁的已婚女性（人口）（人口）（人口）参考局。 2006）。年轻母亲的母亲发病率也较高，包括严重的并发症，例如主要发生在年轻妇女中的劳动或产科瘘管阻塞或产科瘘（Infpa and Engenderhealth，2003； Jarrett，1994）。如果不进行任何干预，就可以导致组织坏死，这可能导致永久性母体发病率，即使不是死亡率。关于母体发病率的数据很少，仅适用于少数情况。在埃塞俄比亚，有24％的妇女按18岁的妇女生育，遭受劳动是46％的生物死亡的直接原因，而有1,000名孕妇的三分之三在孟加拉国也很常见（Populafion参考局，2006年；人满为身，2003； Akhter等，1996）。至关重要的事实是，医学界不知道育儿年龄和繁殖结果之间有据可查的关系的程度是容易生育的身体后果。因此，这项研究具有重要的科学价值。除了物理渠道，画架婚姻还可能通过行为影响健康频道。首先，青年人与较不活跃的健康行为和有限的健康信息有关，这对已婚青少年giris的健康状况产生了负面影响。在孟加拉国，有70％的孕妇20岁以下的Giris不接受天内护理，有90％的人在家中分娩了婴儿。他们获得健康信息的获取很差：20％的青少年母亲对怀孕期间威胁生命的状况知之甚少，大多数（已婚和未婚）对性，避孕或性传播感染或HIV/AIDS（Haider等，1997; Nahar等人，1999; Nahar等，1999; Barkat; Barkat et al and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and and; 青春期Giris获得生殖医疗保健和服务的机会也很差：在孟加拉国，20％以下的母亲中27％不满足避孕的需求，而20至35岁的年龄在20％的年龄中，避孕需要10％（Niport，Mitra Associates和Orc Macro，2001年）。此外，已婚青少年的避孕速度比老年妇女低得多。在南亚，15至19岁的已婚妇女中有9％使用现代违规行为，而孟加拉国的20至24％的妇女中有24％分别为34％和47％（人口参考局，2006年）。使用量较低可能反映出对计划生育的认识不足，期望立即生孩子的期望以及青少年在卫生服务方面的机会更有限。此外，年轻女孩倾向于与年龄较大的男人结婚。撒哈拉以南非洲的研究发现，年龄在15至19岁的吉里斯的丈夫平均比10岁以上（联合国儿童基金会2001年）。在整个WARID期间，随着女性的初婚妇女年龄的平均年龄差异正在减少。在西非，初婚时14至15岁的女孩的平均配偶年龄为12岁，而妇女为24至25岁的妇女为8岁。在南亚也发现了相同的模式（2004年，人口基金）。配偶之间存在较大的年龄差距可以在多种方面导致不良结果。首先，年长的丈夫往往会更有性感，这意味着更大的性传播感染风险（Clark，2004； Luke和Kurz，2002）。年龄差距也与青春期Giri的婚姻缺乏代理有关，这可能导致健康状况不佳。缺乏决策能力可能会转化为较低的再现控制性关系，避孕和生育能力。定性研究还表明，大多数年轻已婚的Giris面临着容易怀孕的压力，并且缺乏生殖控制以避免这种情况（Bledsoe and Cohen，1993； Mensch，Bruce和Greene，1998； Bruce和Clark，2004）。有质量但很少的严格分析表明，在年轻的已婚Giris中，隔离，限制性流动性和缺乏对家庭资源的控制更为普遍（Mensch等，1998）。隔离和成人责任的压力增加可能对心理健康。缺乏流动性也可能导致已婚青少年giris的医疗保健利用率较低。印度的研究表明，已婚青少年的医疗保健决定主要由丈夫和岳母控制（Barua and Kurz，2001）。与流动性有限的行动能力一起，这可能会限制青春期Giris为自己和孩子提供卫生服务的能力。最后，轻松结婚与健康之间的Negafive协会扩展到了下一代。 20岁以下妇女出生的儿童在五岁之前的婴儿死亡率（IMR）较高。在马里，婴儿死亡率为20岁以下的母亲的儿童为每1000名，而母亲的儿童为20岁以下的儿童为201，而20岁以下的儿童为29岁。相似，坦桑尼亚的儿童为164和88，尼泊尔为108和68，在多米尼加共和国（Marthur，Green，Green，Green，Green和Malhotra，2003年）中为71和28。孟加拉国，母亲出生于20岁以下的婴儿的IMR为86岁，而20至29岁的母亲为60岁（Niport，Mitra Associates和Orc Macro，2005年）。青少年母亲儿童的儿童死亡率（CMR）也更高。在肯尼亚，母亲在20岁以下的孩子中出生的儿童的率为48，而20至29岁的母亲出生的儿童为32岁。可比的数字在埃塞俄比亚为90和83；南非40和19；以及埃及的15和13（Marthur，Green和Malhotra，2003年）。在孟加拉国，母亲儿童的CMR为每1000人106 20至29岁的母亲出生的儿童为20岁以下（Niport，Mitra Associates和Orc Macro，2005年）。 [这种相关性的数量是由于较低的医疗保健利用率（例如，免疫抑制率降低）或母亲对儿童对良好健康实践的了解更少。]尚不清楚。]