When the mother is a child: the impact of child marriage on the health and human rights of girls
When the mother is a child: the impact of child marriage on the health and human rights of girls
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DOI：
10.1136/adc.2009.178707
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发表时间：
2010-11-01
影响因子：
5.2
通讯作者：
Raj, Anita
中科院分区：
文献类型：
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作者：
Raj, Anita
虽然上述文献综述提供了与女孩早婚有关的社会脆弱性的重要见解，以及这种早婚和相关的早育对健康的影响，但该综述并未强调基于结婚年龄的风险梯度。在这些分析中，我们使用了来自全国家庭健康调查（NFHS-3）的数据，这是一项针对印度全国代表性妇女样本中孕产妇和儿童健康问题的监测。之所以选择印度作为分析对象，是因为印度在禁止童婚的立法背景下童婚率很高。目前的NFHS-3分析仅限于曾经结婚的20-24岁的人（n= 14628），以提供反映印度现状的样本，但有足够的时间比较成年（20-24岁）结婚者与儿童（< 14岁）、青少年（15-17岁）和青少年晚期（18-19岁）结婚者的婚姻和分娩经历。（具体方法、措施和数据分析程序见网上附录56。）如表1-3所示，分析评估了结婚年龄与社会脆弱性（农村居住、贫困和教育）、性别不平等和暴力（大龄丈夫、丈夫的身体或性暴力、重男轻女）、医疗保健利用（产前护理、间隔避孕药具使用、绝育）、生育控制指标（快速重复分娩、多次意外怀孕）和婴儿/儿童死亡率之间的关联。分析了结婚年龄与HIV血清状态的关系；这些发现不在表格中。调查结果显示，在印度20-24岁的已婚女性中，9.6%的人在14岁之前结婚，只有10%的人在20-24岁结婚。另有25%的人在13-15岁结婚；32.1%的人在16-17岁结婚；23.4%的人在18-19岁结婚。社会人口脆弱性对整个人口来说是规范的；73%的妇女居住在农村地区，超过三分之一（39%）的妇女没有接受过正规教育。值得注意的是，20-24岁结婚的人中有15%没有受过正规教育，而14岁以下结婚的人中有65%没有受过正规教育。在性别不平等方面，15%的总样本报告丈夫年龄≥10岁；三分之一（35%）报告曾遭受丈夫的身体虐待或性虐待；超过五分之一（22%）的人表示重男轻女。生殖保健的利用率很低。17%的妇女报告至少一次怀孕没有产前护理；80%的妇女报告没有间隔使用避孕措施，另有13%的妇女报告进行了女性绝育。值得注意的是，在20-24岁结婚的人中，只有1%的人报告了绝育，而在14岁之前结婚的人中，这一比例为29%。超过四分之一的妇女（28%）报告了快速重复分娩，但不到4%的妇女报告了多次意外怀孕的历史。
While the above literature review offers important insight into social vulnerabilities attached to early marriage of girls, as well as the health impact of such early marriage and related early childbirth, the review does not highlight gradients of risk based on age at marriage. For these analyses, we utilised data from the National Family Health Survey (NFHS-3), a surveillance focused on maternal and child health concerns among a nationally representative sample of women in India. India was chosen for analysis given its high rate of child marriage in the context of legislation against the practice. Current NFHS-3 analyses were restricted to ever married 20–24 year olds (n= 14 628) to provide a sample reflective of current conditions in India but with sufficient time to compare marriage and childbirth experiences of those marrying as adults (20–24 years) relative to those marrying as children (< 14 years), adolescents (15–17 years) and late adolescents (18–19 years).(See online appendix56 for details on methods, measures and data analysis procedures.) As highlighted in tables 1–3, analyses assessed associations between age at marriage and social vulnerabilities (rural residence, poverty and education), gender inequities and violence (older husbands, physical or sexual violence from husbands, son preference), healthcare utilisation (antenatal care, spacing contraceptive use, sterilisation), fertility control indicators (rapid repeat childbirth, multiple unwanted pregnancies) and infant/child mortality. Analysis of association between age at marriage and HIV serostatus was also conducted; these findings are not in the tables.Findings reveal that among married 20–24-year-old females in India, 9.6% report marriage prior to age 14 years and only 10% report marriage at age 20–24 years. An additional 25% report marriage at 13–15 years; 32.1% report marriage at 16–17 years; and 23.4% report marriage at 18–19 years. Sociodemographic vulnerabilities are normative for the population as a whole; 73% of women resided in rural areas, and more than one-third (39%) had received no formal education. Notably, 15% of those marrying at 20–24 years relative to 65% of those marrying at less than age 14 years had no formal education. In terms of gender inequities, 15% of the total sample reported a husband aged≥ 10 years; one-third (35%) reported a history of physical or sexual abuse from husbands; and more than one-fifth (22%) reported son preference. Reproductive healthcare utilisation was low. No antenatal care for at least one pregnancy was reported by 17% of women; no spacing contraceptive use was reported by 80% of women and female sterilisation was reported by an additional 13% of women. Notably, only 1% of those married at 20–24 years reported sterilisation relative to 29% of those married prior to age 14 years. More than one-quarter of women (28%) reported rapid repeat childbirth, though< 4% reported a history of multiple unwanted pregnancies.