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Early marriageDefinitionAs determined by the United Nations
Convention on the Rights of the Child (CRC) occurs when the bride or groom is under 18 years of age
PrevalenceGlobally – 1/3rd of all girls by age 18
1 in 9 by age 15Pakistan – UNICEF & PRB data
7% by age 15
24% by age 18
Early marriage and childbearingSocial and cultural constructSocial and economic outcomes
- loss of peer support- discontinuation of education- fewer future employment opportunities
Consequences of early marriage and childbearingMedical/clinical
Maternal mortality Low birth weightPreterm birthNeonatal, perinatal and infant mortalityProlonged and obstructed labour – VVFAnaemia
Health care seeking behaviour of young married girls
Low utilization of services
Delayed or insufficient utilization of services
Three Delays model – Thaddeus and Maine, 1994
1st delay: delay in deciding to seek care on the part of the individual, family or both
2nd delay: delay in reaching an adequate health care facility
3rd delay: delay in receiving adequate care at the facility
Health care seeking behaviour of young married girls – determinants and barriersIndividual, social and cultural factorsLimited autonomy Financial constraints Restricted mobility Perception of need
Lack of knowledge and education Inability to recognise signs of complication
Lack of information about existing servicesPerception of services – providers’ attitudeViolence and abuse during pregnancy
Policy issues – Health service provisionLack of availability of servicesLack of equipment and suppliesLack of accessibility of servicesDistance to servicesPoor infrastructureNo or minimal transportationTransportation costsProviders training
Health care services for young married women
Neglected cohortDifficult to reachLack of policy and programming
MDGs and early marriage and childbearing
Address morbidity and mortality associated with early childbearing
Invest in policy and programmes to prevent or delay early marriage
Focus on service delivery – strengthen health systems and develop programmatic capacity
Prioritise health and well-being of girls and young women – urged at Women Deliver Conference 2013
To achieve MDGs – Different programmatic approaches and evidence
Approaches - few programmes Preventing complications during pregnancy & childbirthManagement of complications during pregnancy &
childbirth
Interventions and evidencePre-pregnancy counsellingComprehensive ANCIntrapartum care – skilled attendant and EmOCPostpartum care
BUT….. The key issues remain
Timely access and utilization of services
Barriers to access and utilize services
Small scale qualitative study conducted in LebanonAim of the study - identify factors that may influence young
married women’s health care seeking behaviour, their access to and utilisation of health care services
Sampling – purposive – limited to CLAMethodology – in-depth interviews with 3
doctors, 3 nurses and 2 midwives
Selected statistics for comparison
Indicators Palestinian refugees
Pakistan
Youth aged 10-24 years - % of total population
34 32
% of women aged 20-24 years married by age 18
19 24
% of women aged 20-24 years married by age 15
- 7
Total fertility rate 3.2 3
adolescent fertility rate 48 28
Selected findings
Health care seeking behaviour of young married Palestinian refugee girlsInitiation of ANC Number of visits during pregnancy Regularity and punctuality of visitsPostnatal visit
Initiated ANC early in pregnancyFollowed recommended regimenAttended clinics regularityAttended postnatal clinic
Other findingsPreconception classesAppointment systemContinuity of care and familial environmentNo transport costsFree or minimal consultation feesPostnatal home visits
Selected statistics on Palestinian refugees living in Lebanon86.2% ANC coverage6.4 average number of visits during pregnancy86.2% of women with at least 4 antenatal visits92.4% Postnatal visits 100% institutional deliveriesChild immunization – more than 99% Infant mortality – 19/1000 live birthsNeonatal mortality – 14/1000 live birthsMaternal mortality ratio MMR – 14/100,000 live
births among women registered with UNRWA antenatal services
Lessons learned
Increasing accessibility and utilization of services
Health care seeking behaviour can be influenced byIntroduction of preconception classes – health
promotion, counselling, screening/risk assessment, nutrition supplementation
Providing information about servicesMaking services available and affordable to allIncreasing accessibility of services
Reducing distance to facilities Minimising transportation costs
Lessons learned contd:
Improving quality of services Focus on prevention and MCH
MCH programme that reaches out to those in need Accessible to all Addresses the needs of vulnerable groups
Training of health care providersNumber of trained personnel
The way forward:Appropriate policies and proper allocation
regimens.Addressing young married girls in all maternal
and child health (MCH) programmes and policies
Investing in policies and programmes that address young married girls will help accelerate the achievement of internationally-agreed Millennium Development Goals – not only MDG 5 but also MDG 1, 3, 4 and 6.