Donta Balaiah

Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study

BACKGROUND Child marriage is a substantial barrier to social and economic development in India, and a primary concern for womens health. We assessed the prevalence of child marriage-ie, before 18 years of age-in young adult women in India, and the associations between child marriage and womens fertility and fertility-control outcomes. METHODS Data from the National Family Health Survey-3 (2005-06) were limited to a sample of Indian women aged 20-24 years (n=22 807), of whom 14 813 had been or were presently married (ever-married). Prevalence of child marriage was estimated for the whole sample. We used regression models adjusted for demographics, and models adjusted for demographics and duration of marriage to estimate odds ratios (ORs) for the associations between child marriage and both fertility and fertility-control outcomes, in the ever-married subsample. FINDINGS 44.5% of women aged 20-24 years were married before age 18 years, 22.6% were married before age 16 years, and 2.6% were married before age 13 years. Child marriage was significantly associated with no contraceptive use before first childbirth (adjusted OR 1.37 [95% CI 1.22-1.54]), high fertility (three or more births) (7.40 [6.45-8.50]), a repeat childbirth in less than 24 months (3.00 [2.74-3.29]), multiple unwanted pregnancies (2.36 [1.90-2.94]), pregnancy termination (1.48 [1.34-1.63]), and female sterilisation (6.68 [5.78-7.60]). The association between child marriage and high fertility, a repeat childbirth in less than 24 months, multiple unwanted pregnancies, pregnancy termination, and sterilisation all remained significant after controlling for duration of marriage. INTERPRETATION Increased enforcement of existing policies is crucial for prevention of child marriage. Improved family-planning education, access, and support are urgently needed for women married as children, their husbands, and their families to reduce the high fertility and poor fertility-control outcomes of this practice. FUNDING US National Institutes of Health and Indian Council of Medical Research.

The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample

Objective To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India. Design Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations. Adjusted models included maternal and child demographics and maternal body mass index as covariates. Setting India. Population Women aged 15-49 years (n=124 385); data collected in 2005-6 through National Family Health Survey-3. Data about child morbidity and mortality reported by participants. Analyses restricted to births in past five years reported by ever married women aged 15-24 years (n=19 302 births to 13 396 mothers). Main outcome measures In under 5s: mortality related infectious diseases in the past two weeks (acute respiratory infection, diarrhoea); malnutrition (stunting, wasting, underweight); infant (age <1 year) and child (1-5 years) mortality; low birth weight (<2500 kg). Results The majority of births (73%; 13 042/19 302) were to mothers married as minors. Although bivariate analyses showed significant associations between maternal child marriage and infant and child diarrhoea, malnutrition (stunted, wasted, underweight), low birth weight, and mortality, only stunting (adjusted odds ratio 1.22, 95% CI 1.12 to 1.33) and underweight (1.24, 1.14 to 1.36) remained significant in adjusted analyses. We noted no effect of maternal child marriage on health of boys versus girls. Conclusions The risk of malnutrition is higher in young children born to mothers married as minors than in those born to women married at a majority age. Further research should examine how early marriage affects food distribution and access for children in India.

Association between adolescent marriage and marital violence among young adult women in India

To assess whether a history of adolescent marriage (< 18 years) places women in young adulthood in India at increased risk of physical or sexual marital violence.

Determinants of spacing contraceptive use among couples in Mumbai: a male perspective.

This study aimed to determine the factors influencing the use of spacing contraceptive methods in India, particularly from mens perspective. Data were obtained through a semi-structured interview schedule from 2,687 married men aged between 18 and 40 years from central Mumbai City, India, during 1999. Chi-squared tests and binary logistic regression analysis was carried out to determine the relationship between various variables and the likelihood of a couple using spacing contraceptive methods. Of the 2,687 couples, 1,395 (51.9%) were using one or other method of spacing contraceptives and 1,292 (48.1%) were not using any method at the time of survey. Male participation in contraceptive use was 23% (condom and withdrawal). The results indicate that the use of spacing contraceptive methods was significantly higher among those couples where the men desired one or two children (OR=4.3), had knowledge of five or more contraceptive methods (OR=1.9) and discussed with their wives obtaining family planning information (OR=3.2), spacing (OR=2.7) and permanent (OR=2) contraceptive methods. Age, income, desired number of children, knowledge of a greater number of contraceptive methods, inter-spouse communication regarding obtaining family planning information, spacing and permanent methods were found to be strong predictors of the use of spacing contraceptive methods. The study underlines the importance of intervention programmes aimed at promoting a small family norm, increasing the number of contraceptive choices available and encouraging inter-spouse communication. Hence, policymakers and programme managers should encourage interventions in this direction, targeting couples to enhance the use of spacing contraceptive methods.

Cluster randomized controlled trial evaluation of a gender equity and family planning intervention for married men and couples in rural India.

Background Despite ongoing recommendations to increase male engagement and gender-equity (GE) counseling in family planning (FP) services, few such programs have been implemented and rigorously evaluated. This study evaluates the impact of CHARM, a three-session GE+FP counseling intervention delivered by male health care providers to married men, alone (sessions 1&2) and with their wives (session 3) in India. Methods and Findings A two-armed cluster randomized controlled trial was conducted with young married couples (N = 1081 couples) recruited from 50 geographic clusters (25 clusters randomized to CHARM and a control condition, respectively) in rural Maharashtra, India. Couples were surveyed on demographics, contraceptive behaviors, and intimate partner violence (IPV) attitudes and behaviors at baseline and 9 &18-month follow-ups, with pregnancy testing at baseline and 18-month follow-up. Outcome effects on contraceptive use and incident pregnancy, and secondarily, on contraceptive communication and men’s IPV attitudes and behaviors, were assessed using logistic generalized linear mixed models. Most men recruited from CHARM communities (91.3%) received at least one CHARM intervention session; 52.5% received the couple’s session with their wife. Findings document that women from the CHARM condition, relative to controls, were more likely to report contraceptive communication at 9-month follow-up (AOR = 1.77, p = 0.04) and modern contraceptive use at 9 and 18-month follow-ups (AORs = 1.57–1.58, p = 0.05), and they were less likely to report sexual IPV at 18-month follow-up (AOR = 0.48, p = 0.01). Men in the CHARM condition were less likely than those in the control clusters to report attitudes accepting of sexual IPV at 9-month (AOR = 0.64, p = 0.03) and 18-month (AOR = 0.51, p = 0.004) follow-up, and attitudes accepting of physical IPV at 18-month follow-up (AOR = 0.64, p = 0.02). No significant effect on pregnancy was seen. Conclusions Findings demonstrate that men can be engaged in FP programming in rural India, and that such an approach inclusive of GE counseling can improve contraceptive practices and reduce sexual IPV in married couples. Trial Registration ClinicalTrials.gov NCT01593943

Association of Schistosoma haematobium and Human Papillomavirus in Cervical Cancer

BACKGROUND The association between Schistosoma haematobium and cervical cancer has been reported for a long time. However, recently human papillomavirus, a cofactor in the genesis of cervical cancer, has been confirmed. A case of squamous intraepithelial lesion after S haematobium infection is presented, and the relation between schistosomiasis, human papillomavirus and squamous intraepithelial lesion, with long-term follow-up by Papanicolaou smear, is discussed. CASE A 33-year-old, normal, healthy woman with a history of Copper intrauterine device (IUD) use for 3.9 years presented for her annual contraceptive follow-up. Her Pap smear revealed inflammation with a S haematobium egg. She was followed up with Pap smears for 4 years. Retrospective contraceptive history revealed use ofa copper IUD on 5 occasions with a total duration of 13 years and 1 month. Similarly, annual follow-up of Pap smears for the past 13 years showed mild inflammation with bacterial vaginitis and monilial infection. Subsequent smears showed an Actinomyces-like organism and then human papillomavirus infection with atypical squamous cells of undetermined significance followed by human papillomavirus-associated low/high grade squamous intraepithelial lesion. CONCLUSION Caution is required while screening routine Pap smears. Apart from nuclear abnormalities, one can observe unusual findings. Long-term followup by Pap smear following detection of S haematobium revealed that in the absence of human papillomavirus, S haematobium alone is not the causative agent for the abnormal proliferation of squamous epithelium of the cervix. Genital Schistosomia acts as a cofactor by traumatizing the genital epithelium or immune suppression to favor human papillomavirus infection.

Impact of the RHANI Wives intervention on marital conflict and sexual coercion

To assess the effects of the RHANI (Reducing HIV among Non‐Infected) Wives intervention on marital conflict and intimate partner violence (IPV) in urban India.

Maternal morbidity associated with violence and maltreatment from husbands and in-laws: findings from Indian slum communities

BackgroundIntimate partner violence (IPV) victimization is linked to a broad range of negative maternal health outcomes. However, it is unclear whether IPV is directly related to poor maternal outcomes or whether IPV is a marker for other forms of chronic, mundane maltreatment of women that stem from the culture of gender inequity that also gives rise to IPV. To determine the prevalence of non-violent forms of gender-based household maltreatment by husbands and in-laws (GBHM), and violence from in-laws (ILV) and husbands (IPV) against women during the peripregnancy period (during and in the year prior to pregnancy); to assess relative associations of GBHM, ILV and IPV with maternal health.MethodsCross-sectional data were collected from women <6 months postpartum (n = 1,039, ages 15-35 years) seeking child immunization in Mumbai, India. Associations of IPV, ILV and GBHM during the peripregnancy period with maternal health (prenatal care in first trimester, no weight gain, pain during intercourse, high blood pressure, vaginal bleeding, premature rupture of membranes, premature birth) were evaluated.ResultsOne in three women (34.0 %) reported IPV, 4.8 % reported ILV, and 48.5 % reported GBHM during the peripregnancy period. After adjusting for other forms of abuse, IPV related to pain during intercourse (AOR = 1.79); ILV related to not receiving first trimester antenatal care (AOR = 0.49), and GBHM remained associated with premature rupture of membranes (AOR = 2.28), pain during intercourse (AOR = 1.60), and vaginal bleeding (AOR = 1.80).ConclusionAfter adjusting for ILV and IPV, peripregnancy GBHM remained significantly associated with multiple forms of maternal morbidity, suggesting that GBHM is a prevalent and reliable indicator of maternal health risk.

Reproductive health concerns of women contending with spousal violence and husband's alcohol use in a Mumbai slum community

Spousal violence is associated with higher gravidity, and husband’s frequent alcohol use is associated with induced abortion among women residing in Mumbai slum communities.

Age at menarche, education, and child marriage among young wives in rural Maharashtra, India.

India is home to 33% of the 720 million women worldwide who were married before the age of 18 years [1]. Menarche has historically been viewed as an indicator of a girl’s readiness to marry [2], but recent research on this issue is limited. The present study examined associations between age at menarche and age at marriage among young wives who were baseline respondents in the CHARM study—a two-armed randomized controlled trial evaluating a male engagement-focused family planning intervention in rural Maharashtra, India.