Presenter: Dr Dina Neelofur Khan
Early marriage
 Definition
As 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
Prevalence
 Globally – 1/3rd of all girls by age 18
1 in 9 by age 15
 Pakistan – UNICEF & PRB data
7% by age 15
24% by age 18
Early marriage and childbearing
 Social and cultural construct
 Social and economic outcomes
- loss of peer support
- discontinuation of education
- fewer future employment opportunities
Consequences of early marriage
and childbearing
 Medical/clinical
 Maternal mortality
 Low birth weight
 Preterm birth
 Neonatal, perinatal and infant mortality
 Prolonged and obstructed labour – VVF
 Anaemia
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 barriers
Individual, social and cultural factors
 Limited autonomy
 Financial constraints
 Restricted mobility
 Perception of need


Lack of knowledge and education
Inability to recognise signs of complication
 Lack of information about existing services
 Perception of services – providers’ attitude
 Violence and abuse during pregnancy
Policy issues – Health service provision
 Lack of availability of services
 Lack of equipment and supplies
 Lack of accessibility of services
 Distance to services
 Poor infrastructure
 No or minimal transportation
 Transportation costs
 Providers training
Health care services for young married
women
 Neglected cohort
 Difficult to reach
 Lack 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 & childbirth
 Management of complications during pregnancy & childbirth
 Interventions and evidence
 Pre-pregnancy counselling
 Comprehensive ANC
 Intrapartum care – skilled attendant and EmOC
 Postpartum care
BUT….. The key issues remain
 Timely access and utilization of
services
 Barriers to access and utilize services
Small scale qualitative study
conducted in Lebanon
 Aim 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 CLA
 Methodology – 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 girls
 Initiation of ANC
 Number of visits during pregnancy
 Regularity and punctuality of visits
 Postnatal visit




Initiated ANC early in pregnancy
Followed recommended regimen
Attended clinics regularity
Attended postnatal clinic
Other findings
 Preconception classes
 Appointment system
 Continuity of care and familial environment
 No transport costs
 Free or minimal consultation fees
 Postnatal home visits
Selected statistics on Palestinian refugees
living in Lebanon
 86.2% ANC coverage
 6.4 average number of visits during pregnancy
 86.2% of women with at least 4 antenatal visits
 92.4% Postnatal visits
 100% institutional deliveries
 Child immunization – more than 99%
 Infant mortality – 19/1000 live births
 Neonatal mortality – 14/1000 live births
 Maternal 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 by
 Introduction of preconception classes – health
promotion, counselling, screening/risk assessment,
nutrition supplementation
 Providing information about services
 Making services available and affordable to all
 Increasing 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 providers
 Number 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.
Thank you