Child Marriage, Reproductive Outcomes, and Service Utilization among Young Afghan Women: Findings from a Nationally Representative Survey in Afghanistan

Abstract

This study explored the prevalence of child marriage and its association with reproductive outcomes and service utilization among young women in Afghanistan. We conducted a secondary analysis of data from the 2015 Afghanistan Demographic and Health Survey (DHS), focusing on women aged 20–24 years old based on the United Nations’ recommendation on child marriage study. Multivariate logistic models examined the association between child marriage, reproductive outcomes, and service utilization. An estimated 52% of the Afghan women aged 20–24 married at ages less than 18 years. Poverty and illiteracy were associated with the higher likelihood of early marriage. There was a significant negative relationship between child marriage and history of rapid repeat childbirth, delivery by skilled personnel, and institutional delivery. In both adjusted and unadjusted models, women married at age ≤14 were more likely to experience terminated or unintended pregnancy, inadequate ANC, unmet need for family planning, and fistula; while, for those married at age 15–17 years, only terminated or unintended pregnancy remained significant. Strict international law enforcement and advocacy are needed in the current situation of Afghanistan to increase young women's education, promote their civil rights, and improve their autonomy and role in decision‐making concerning their fertility preferences and reproductive health.

Patterns and Drivers of Internal Migration and Its Association with Access to Reproductive and Maternity Care Among Women in Pakistan: Evidence from a Recent National Survey

“…The likelihood of having adequate ANC was approximately 2 to 4 times higher in all migration streams compared to rural non-migrants. It appeared that women aged 25-34 had the highest proportion of adequate ANC compared to other groups and the odds of having adequate ANC was 27% higher among this age group compared to the reference group (15)(16)(17)(18)(19)(20)(21)(22)(23)(24). The women with higher education had a substantially higher chance of having adequate ANC; with higher education at the top (OR= 14.70, 95% CI:10.82.19.98) followed by secondary (OR= 5.59, 95%CI: 4.50-6.95), and primary (OR= 2.52, 95%CI: 2.02-3.14).…”

“…Similarly in our study, women with higher education and wealth index were more likely to have adequate access to family planning, ANC, and delivery health facilities. Besides, well-educated and economically independent women are more likely to seek necessary reproductive and maternity care through more power to negotiate their reproductive rights with their partner, particularly in man-dominant societies such as Pakistan in which most decisions related to the health of household members are made by men (19,20).…”

Development of a Survey-based Women Empowerment Index for Afghanistan (SWEIA): An Explanatory Analyses of the Afghanistan Demographic Health Survey 2015

“…This study contributes to the existent literature by employing a comprehensive list of variables concerning women's empowerment (2,10,15,18,(20)(21)(22) to construct a country-speci c index measuring women's empowerment in one of the poorest countries in the world where the violation of women's rights has been a longstanding rampant issue and barriers toward empowering women are abundant (33,34). Although there are similar conceptualizations of women empowerment in studies from other regions such as South-East Asia (22), Sub-Saharan Africa (18), and East Africa (15), this study mostly builds upon the results from Ewerling et al study (19) in which the authors attempted to develop a region-speci c index, namely SWEPR, to measure the women empowerment in 34 African countries.…”

“…In Afghanistan, women's economic empowerment is hindered by low literacy, culturally sensitive customs, and man-dominant norms which prevent young girls to present at school, burden married women with domestic work and child fostering at home, and prohibit women from having a land-or property; these barriers could limit the educational and economic opportunities that can be achieved otherwise. (33)(34)(35)(36). Thus, concerted efforts to promote the access of underprivileged Afghan women to economic and job opportunities are necessary.…”

Patterns and Drivers of Internal Migration and Its Association with Access to Reproductive and Maternity Care Among Women in Pakistan: Evidence from a Recent National Survey

“…In terms of adequate ANC (≥4), the women who moved across (urban to urban), lived (urban non-migrant), moved to (rural to urban), or left (urban to rural) the urban areas had higher (15)(16)(17)(18)(19)(20)(21)(22)(23)(24). The women with higher education had a substantially higher chance of having adequate ANC; with higher education at the top (OR= 14.70, 95% CI:10.82.19.98) followed by secondary (OR= 5.59, 95%CI: 4.50-6.95), and primary (OR= 2.52, 95%CI: 2.02-3.14).…”