exploratory study of reproductive health behaviors and sexual problems among married adolescent...
TRANSCRIPT
Exploratory Study of Reproductive Health
Behaviors and Sexual Problems among married Adolescent Girls in Egypt
Dr. Manal M. M. Darwish Dr. Wafaa S Hamza Mirette M. W. Aziz Amira F. EL-Gazzar
Introduction Early marriage of girls is a violation of human rights as it deprives them of freedom, opportunity for personal development, and negatively impacts other rights.
Early marriage is generally associated with early childbearing and high fertility, both of which pose health risks to women and their children.
Married adolescent girls are often are socially isolated, have little or no autonomous decision-making power, lack accurate knowledge related to sexual and reproductive health, and lack basic life skills and economic opportunities.
Among Egyptian women, 13 percent of 15-19 years old are married (El-Zanaty&Way, 2008).
Objectives of the study:• To understand the SRH behaviors and experience of
MAGs in Egypt by investigating three key areas:
▫Marriage experience of MAGs
▫Husband-wife communication
▫Utilization of reproductive health services
among MAGs.
• To understand the role of mothers/mothers-in-law in
influencing the experience of MAGs in Egypt.
Methodology: The target populations were:
◦ Married adolescent girls (16-19 ys.) who have
been married for 1-3 years
◦ Mothers /mothers-in-law of married adolescent
girls.
In-depth interviews were conducted with MAGs
(n=20) while focus group discussions were
conducted with mothers / mothers in law (n=4)
Data collection was done in three villages in Assiut
Governorate.
MethodologyBoth IDIs and FGDs took place at the
health units. Participation in the research study
was completely voluntary and informed consents were obtained from all subjects. For MAGs, both her consent and that of her guardian were obtained (if she is <18).
Study results
◦ Background characteristics of MAGs:
-The average age of participants : 18.4 years
-Education- Illiterate : n= 4
- Primary: n= 6
- Intermediate: n=3
- Secondary: n=7
-None of the MAGs were working for cash.
-Two of the girls had more than 35 years of age gap with their husbands.
Study Results
Engagement
• There was no clear pattern for length of engagement.
Engagement duration ranged from 0-30 months with
average engagement duration of 9.5 months Engagement
periods varied from couple of days to couple of years
with no direct relation with degree of feeling that she
knew her husband well by the time they got married.
قطن ” بسرح كنت بصراحة انا عليه، وجاب ، متعرفتش على اتكلم جه هوهبـ بعدها بالدهب اتفاجئت انا معرفتش، وانا ودخل 3الدهب، كتب “ أيام
(MAG ) Distribution of wife’s feeling of knowing husband at the time of marriage
Study results
Wedding nightBoth MAGs & mothers / mothers-in-law agreed on disappearance of traditional i.e. manual type of defloration. However, almost always a kind of dissemination was required to prove virginity of the girl and potency of the husband. which lead to fear, worries, pressure& force and
Bleeding, injury, fear, embarrassment were the main problems at the wedding night. In one case there was violence to get defloration done in time.
شفت” لما أكتر وتعبت بيتى، مش بيت غريب، بيت داخلة انى حاسه غريب، احساس . أنا ان حسيت غريبة، بحاجة حسيت أخوى مرت وأخت أخوى، ومرت وأخته، الداية،
... ده اليوم فى يعنى 5هدبح . 6انفاروهوه، حاجة فى اكيد يبقى جوه واقفين انفار ... األرض،.. فى وقعدونى الفستان قلعونى حاجة قال وال اتكلم ال وهوه هتحصل
“... حصل اللى حصل (MAG 18 )وخالص،
Study resultsSexual relations
Most of MAGs didn’t have any information about sexual relations before marriage which was explained by being a taboo to talk about this subject even with mothers. Mothers' advice is only about husband obedience and house chores.
حسسوني” يشجعني حد مالقتش هيحصل اللي ايه اسأل حاولت لما اناطيب تجوزوني قدرتوا خاالكوا اللي طيب غلط، سؤال بسأل اني
( ( MAG, 17 “فهموني
About half of MAGs (9 out 20) reported dissatisfaction sometimes or most of the time. In most cases dissatisfaction was mainly due to H/W miscommunication, physical violence, age gap, lack of knowledge or painful intercourse.
وبعدين”... بسرعة مصلحته يخلص عليا، ينام تنام ما اول جنبي، بتبقي البت اناحاجة ....“ بأي بحسش ما وينام ظهره، يديني
Study results
• Husband-wife communication
Communication between MAGs and their husbands was limited especially when there was large age difference or the girl is not educated.
برضه”... فالتاني كتير الحياة في خبرة ملياش انا معزور برضه هو " .... كتير حاجات في رائي مابياخدش
(MAG, 18 years old)
Study resultsInformation needs
◦ All MAGs requested information about details of wedding night and communication skills, not just house chores. Most of MAGs do not have enough information about their body, health, pregnancy, child birth, family planning, sexual relations. They all wanted to know more about all these topics.
- يوم”... - اول يقوللولي كتير، حاجات يقولوا وكيلي الله مفروض كانابكي قعدت الصبح جم لما أنا ده وكذا، كذا يحصل البيت تدخلي
معايا هينام انه تفهميني مفروض مش قلتلها خالتي في ومسكتمش البيت ليه، بيعملوها وال ايه، دي الحاجة عارفة مكنتش انا وكده،يشاركني انه المفروض بيتها تنظف الواحدة ان وال بس، وشرب اكل
“... معاه حاجة كل (MAG, 17)في
Health services utilization
-All MAGs had variable number of ANC visits regardless of their socioeconomic, demographic and husband wife communication factors.
-Hospitals and private clinics were the main sites for provision of ANC while the role of health unit was confined to TT vaccine.
- Hospital delivery was found in most of the cases. Only one MAG refused to deliver in a hospital and insisted to deliver at home and to be attended by Daya due to her bad experience with a relative.
الوقت” فى يعنى، أختى تعتبر واحدة مع المستشفى رحت كنت اصلى . ... العظيم والله تالتة أو قلمين ضربها الدكتور فيه، عتموت كانت اللى
... كده رجليها شاحطين وهما كده ومنظرها بعينى شفتها حاجة أنا ... لو قلت انا عاد ساعتها من خالص صعبة حاجة كده، رجليها وشاحطين
“. المستشفى هروح مش انا هموت ,MAG) كنت19)
Study results
Study results
Delaying first pregnancy
None of our MAGs intended to delay the 1st pregnancy because either they wanted to, misconceptions, social pressure & husband refusal, not enough time/knowledge or feeling lonely.
) .. . فيها” مخلفتش اللى الفترة مأساة عشنا حماتى معاى ) 3انا ، شهورعايزة كانت هيه بس، واحد غيره مفيش هوه أصل لها، بالنسبة هى
عند نروح تعالى اكشفى، تقوللى، شوية كل وهيه بسرعة، ولده تشوف“... وكده ( MAG,18) الشيوخ
Study resultsBirth spacing
Most of our participants accepted FP for spacing after the 1st baby except for those seeking a boy, lacking knowledge about FP, social security, misconceptions and husbands’ refusal.
Only two MAGs (with relatively high education, SES and good H/W communication) consistently used FP. Others either did not use at all or used inconsistently.
Mothers / mothers in law
Socio-demographic characteristics
◦ Forty )40( mothers and mothers-in-law participated in FGDs. ◦ Their age ranged from 35-70 years
◦ The majority of them )67.5%( had never been to school, about 20% had completed their 2ry technical education.
◦ The majority )82.5%( were not working for cash.
Study results
Study results
Reasons for early marriage
o Ensuring her virginity, the concept of “El Sotra” and social security
o Appearance of the suitable person
o The younger the better
o To protect the girl’s reputation
o Fear of losing fertility
o Social pressure سنة خالص خلفتها ماتت..لواحدة مننا المؤاخذة 30.البت بعدالـ“
“صندوقها بيكش .”(Mother(
"النغم اللى برة يهوس البيت و يهوس البت ذات نفسها, البت تيجى باكية من كالم الناس“
(Mother-in- law(
Opinions about delaying of first pregnancy Nearly all mothers and mothers-in-law totally refused the delay of the 1st pregnancy either for assurance of couples fertility or for fear of method induced infertility.
, , , أسأل"... شهر، ثانى ومن بتى جوزت أنا طول على يحملوا نحبهم أحنا , , شاالله, ان براحتها وبعديها عيل أول تجيب نفسى أل وال جت الدوره قلقانه
, 5تستنى , , وال حتخلف بتى أشوف عيل أول فى نفسى سنين عشر سنين ".... حتخلف )Mother- El-Shaghba )مش
According to almost all mothers and mothers-in-law opinion, all husbands will refuse to delay 1st pregnancy. In a few cases it was acceptable for economic reasons only.
.... , , غيرها"... ويجيب يخلصها يخليهاش ما تخلف عايزه مش لو”... , عايزاه..... مش تبقى منه تخلف عايزه مش طالما -Mother) يزعطها
in -law)
Study results
Study results
Mother daughter communication about marriage
Most of mothers and mothers-in-law do not talk about sexual issues with their daughters before marriage as they think girls know all about sexual life from media and friends. Mothers and mothers in law were not mentioned as a source for such information. The recommended sources were other relatives, older sister and friends.
وجوزها” جوزها،هى طباع وتعرف تخش للبنات،البنت منقولش ألإحنا“ دعوة ملناش حرين
ChallengesDistributing consents forms by the
nurse/raeda on invitation and orientation day increased the possibility of withdrawal due to husband refusal
The need for guardians’ consents )if MAG is <18(
The need for signed consent with high rate of illiteracy in rural communities
Meeting selection criteria for MAGs.Determining MAG current age and age at
marriage
Recommendations
Support delaying marriage of adolescents through ensuring school attendance
Enforce laws concerning minimum age of marriage and marriage registration
Counseling services for married and unmarried young females about sexual relations, life skills and H/W communication.
Awareness raising campaigns for parents about risks of early age at marriage and about benefits of birth spacing
Training doctors and nurses to be able to handle sexual problems of married couples.
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