CHAPTER 2: SOCIO-DEMOGRAPHIC AND ECONOMIC
3.5. SUMMARY OF LITERATURE REVIEW
To understand the topic and the current scientific discussion related to the study’s objectives, this chapter presented and discussed material published by authors and institutions dealing with women’s SRHR issues and early marriage practices. The chapter started by addressing early marriage practice, its trends, determinants that influence its occurrence, impact of the practice for adolescent well-being as well as a discussion about interventions to end and prevent the practice. Findings from Developing Countries showed that early marriage occurrence rates are still higher in the poorest regions of the globe. In these areas, as reported in previous studies, chances are that most of the girls under 18 years of age may be forced to become child brides. Mozambique is among the 10 countries with the highest proportion of early marriage rates globally. Different factors and contexts explain variations in the occurrence of early marriage. Therefore, disparities in the proportion of young married girls between and within countries should be considered as well as impact of their early marriage in women’s well-being. With respect to the impact of early marriage in women’s well-being, particularly their health, the literature shows that early marriage practice takes away women’s freedom and therefore opportunities for personal happiness and growth.
The literature also shows that child marriage practices affect girls’ educational attainment. Childbearing in the context of early marriage happens soon after marriage, when the young bride’s reproductive system is not physical prepared for the pregnancy. As a result, health complications related to pregnancy may occur, leading sometimes to maternal death as well as neonatal and infant death. Due to young married girls’ low level of education and difficulties in accessing ANC services, the unborn babies can also be at risk of being born with low birth weight and other health complications. Evidence also showed that young married
79 girls are at risk of exposure to intimate partner violence, which will affect their decision to seek appropriate medical care such as the use of modern contraceptive methods or seeking ANC during pregnancy. Lack of access to basic reproductive health services such as contraceptives can increase young married girls’ risk of contracting HIV and other STIs. The implications of the findings are that early age at marriage contributes to the spread of HIV and in contrast “the higher age at marriage the longer the period of premarital exposure to the risk of infection”
(Bongaart, 2006). Interventions aimed at preventng and fighting child marriage have been implemented in areas where the practice occurs. Those involve supporting girls in all spheres of their lives and creating a supportive legal and social environment so they can exercise their rights. Girls’ rights, particularly related to SRHR in Developing Countries, are threatened, and data regarding the proportion of contraceptive use and ANC attendance among young married girls provides evidence of this dramatic scenario.
The second section of this chapter presented and discussed data related to modern contraceptive use patterns among married women in Developing Countries, the determinants that influence women’s decision to use contraceptives as well as impact of modern contraceptive methods for women’s well-being. Data from the early 1990s to 2012 showed that within developing regions, Latin America and the Caribbean presented higher proportions of married women using modern contraceptive methods, followed by Asia and then SSA.
Regional disparities in the proportion of married women using modern contraceptive methods were also found between regions and within regions. Overall in Developing Countries, particularly SSA, contraceptive uptake is still low, with a high unmet need for different modern contraceptive methods (Ayanore et al., 2016; Darroch & Singh, 2013; Population Reference Bureau, 2008).The primary contraceptive methods of choice include female sterilization, intrauterine devices and oral contraceptives. However, studies have showed flows in the use of these methods. For example, the number of women using less preferred contraceptive methods such as condoms (both male and female) have experienced an increase. This may be due to the impact of some factors that can influence women’s decision to use the methods that can vary among regions. Age differentials in the proportion of women using contraceptive methods showed lower rates of use among young women between 15 and 19 years old and higher rates among adult women between 25 to 29 years old.
With that being said, different individuals and external exposure as defined within the three structures of the theory of gender and power (sexual division of labour, sexual division of power and the structure of affective attachments or social norms) were presented and discussed based on evidence from the literature. Therefore, guaranteeing women’s access to
80 modern contraceptive use through the elimination of the barriers that influence its use could have a positive impact on women’s well-being, particularly for their SRH. Several studies reviewed argued that contraceptive use could help reduce maternal mortality and morbidity, including child mortality. Modern contraceptive method use, especially condoms, could help prevent HIV and other STIs, and help prevent mother-to-child transmission of HIV. Use of modern contraceptive methods could improve couples’ economic situation and consequently their well-being by allowing the spacing out of births and a reduction in the number of children born. Effective and consistent modern contraceptive use, allied with ANC visits during pregnancy can treat and prevent health complications related to pregnancy in order to reduce maternal and child mortality.
The third and last section of this chapter discussed the ANC attendance situation in Developing Countries, with emphasis on SSA where the study area is located. The literature showed variations in the proportion of women attending these services during pregnancy. This proportion is realistically higher worldwide, particularly among developed countries and relatively lower in Asia and the SSA region (MISAU et al., 2013; O’Connell et al., 2015; Singh et al., 2012; Tarekegn et al., 2014; WHO, 2003). The chapter further addressed determinants that influence women’s decision to use these services. In this review, several factors were identified that prevent pregnant women from accessing full and effective ANC services. Socio- cultural, religious and economic influences affect women’s decision to use ANC services (MISAU et al., 2013; Pell et al., 2013; Rai, 2015; Tarekegn et al., 2014; Upadhyay et al., 2014).
The section reported that husbands and other extended family, such as mothers-in-law, influence women’s decision to seek ANC visits. In the context where women live in urban areas and are educated and financially stable, the probability of using ANC services increases.
By contrast, women residing in poor regions that are less educated, with fewer financial means and low decision-making power within the household are less likely to seek ANC services during pregnancy. Other determinants identified in this review that influence ANC attendance include: religious beliefs against use of ANC services, intimate partner violence, lack of knowledge regarding ANC benefits, women’s age and residency location. The majority of women below 18 years old reported low or later attendance to ANC when compared to older women above 20 years.
To finalise, the chapter discussed the possible impacts of ANC attendance for women’s well-being, as addressed in much of the literature. Studies found that multiple interventions offered to women during ANC visits aim to prevent and treat health complications related to pregnancy. Thus, higher rates of maternal and child mortality and morbidity would be
81 prevented, contributing to the mother’s and baby’s well-being (Gill et al., 2007; Simkhada et al., 2010; Tarekegn et al., 2014; UNICEF, 2016; USAID, 2004; WHO, 2003; 2006).
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