1 Age at first marriage, use of contraception, and gender in Afghanistan
Ana Paula Verona1 Laura Wong2 Claudio Santiago Dias Jr3 Vanessa Di Lego4
Abstract
Afghanistan has simultaneously undergone a delay of the female age at marriage and a rapid increase in the use of contraception. These changes are of great importance given the high level of fertility and the multiple forms of gender-based discrimination that Afghan women traditionally suffer. Using the 2010 Afghanistan Mortality Survey (AMS), which is part of the worldwide MEASURE DHS project, we examine the association between age at first marriage and contraceptive use in Afghanistan among nonpregnant married women aged 15-49 years old. Our main finding does not support our hypothesis that women who have an earlier marriage are less likely to use contraceptive methods. One possible explanation is that women who postpone marriage in Afghanistan (at age 20 or more) are less likely to avoid pregnancies because their “delay”, which is not culturally expected, relatively reduces their exposure time to childbearing.
Key-words: first marriage, contraception, gender, Afghanistan
1
Professor at the Department of Demography/Cedeplar/Universidade Federal de Minas Gerais
2 Professor at the Department of Demography/Cedeplar/Universidade Federal de Minas Gerais 3 Professor at the Department of Sociology/Universidade Federal de Minas Gerais
4
Graduate student at the Department of Demography/Cedeplar/Universidade Federal de Minas Gerais
2 Introduction
In 2013, the Afghanistan Gender Inequality Index (GII)5 score was 0.705 ranking it at 149 out of 187 countries. Certainly, Afghan women are among the most vulnerable in the world. The vulnerability of their basic rights has been observed in different spheres, confirming the multidimensional nature of gender inequality. Discrimination against women includes, but it is not limited to reduced access to health care services, high level of mortality (especially maternal deaths), high exposure to different kinds of violence and abuse, diminished access to education and work activates, and restricted participation in public political spaces. Many women, particularly those of disadvantaged social groups, are at risk of discrimination on multiple grounds, suffering different kinds of challenges and abuse simultaneity.
One important indicator of women´s status and empowerment is the female age at first marriage. Younger married women frequently have reduced autonomy as well as lower emotional and financial independence. In different developing contexts, early age at first marriage has been strongly connected to high adolescent and total fertility, lack of spacing of childbirths, high maternal mortality, and elevated prevalence of domestic violence (Singh and Samara, 1996; Jensen and Thornton, 2003).
Certainly, early marriage has been a cause of concern because of different reasons. One important issue includes the child marriage, which is still a harsh reality for too many young women in Afghanistan (UNFPA, 2012). Of note, low age at marriage has been associated to lower access to education and reduced labor market participation as well as lower women’s decision-making power in the household (Jensen and Thornton, 2003). Other studies have found a consistent relationship between early marriage and poverty (Dahl, 2010).
In addition to the strong influence of Islamism and conservative values on gender roles, the Taliban regime, that ruled Afghanistan from 1996 until 2001, denied or limited the majority of women’ rights. Some restrictions included the ban on education, minimum participation in economic activities, and lack of freedom of movement. However, since the overthrow of the Taliban regime, the Afghan women’s rights have gradually improved (UNFPA, 2012). In fact, Afghanistan has experienced
5
The GII measures gender inequalities in three aspects of human development—reproductive health, empowerment, and economic status. http://hdr.undp.org/en/content/gender-inequality-index-gii
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remarkable social and cultural changes over the last decade. Some of the include the rise in the average number of schooling years among female adolescents, the recent delay of the female age at marriage, and the rapid increase in the use of contraception (AMS 2010; NRVA 2011/2012).
Different sources have showed that the use of contraception has substantially increased in Afghanistan. According to the 2004 and 2014 Population Reference Bureau (PRB), the proportion of Afghan married women aged 15 to 49 who were using contraception increased from 5% in 2004 to 21% in 2014. Data from the 2010 DHS confirmed this share and found a contraception prevalence of 22% at that year in Afghanistan. The fast growth of the use of contraceptive methods suggests that part of Afghan women have had better access to them and probably have changed their reproductive preferences towards lower fertility.
Using the 2010 Afghanistan Mortality Survey (AMS), which is part of the worldwide MEASURE DHS project, we examine the association between women’s age at first marriage and contraceptive use in Afghanistan. More specifically, we investigate nonpregnant married women age 15-49 years old. This association is of great importance given the high level of fertility and the multiple forms of gender-based discrimination that Afghan women traditionally suffer.
Method and Data
This study uses data from the Afghanistan Mortality Survey (AMS) 2010, which was carried out by the Afghan Public Health Institute (APHI) of the Ministry of Public Health (MoPH) and the Central Statistics organization (CSO) Afghanistan. Technical assistance for the survey was provided by ICF Macro, the Indian Institute of Health Management Research (IIHMR) and the World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO). The AMS 2010 is part of the worldwide MEASURE DHS project that assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs.
The AMS 2010 gathered data from 47,848 women age 12-49 in 34 provinces of the country. The survey was designed to measure mortality levels and cause of death, with a special attention on maternal mortality. The survey also provides current data on fertility, family planning and the extent of utilization of maternal and child health services. The question about current use of contraception was asked only for those who
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were currently married (26,045 women) and not pregnant at the time of the survey. Using these criteria of selection, 21,308 nonpregnant married women answered the question about current use of contraception and 26.8% of them confirmed that they were using contraception at the time of the survey.
This study makes use of logistic regression models to examine the association between age at first marriage and use of contraception among nonpregnant married women age 15 to 49 years in 2010 in Afghanistan. The binary response variable correspond to the group of those were using contraception at the time of the survey (reference category) and those nonpregnant married women who were not using.
The main independent variable is the age at first marriage, which is originally a continuous variable. However, in this study, we grouped it into four ranges of age: (1) age at marriage lower than 15; (2) between 15 and 17; (3) between 18 and 19; (4) and 20 or higher. The reference group is the youngest one, that is, women who married for the first time at age 14 or less.
The following covariates were included in the multivariate models: (1) Age: seven age groups: from 15-19 (reference) to 45-49 years,
(2) Five education levels: no education; primary; madrassa; secondary; and higher, (3) Place of residence: rural area (reference) or an urban area,
(4) Region of residence (North Eastern is the reference).
(5) Number of living children: zero, one to two, three or four, five or more.
Results
Table 1 presents the percent distribution of currently nonpregnant married women age 15-49 according to use of contraception and selected variables. With the exception of the two oldest age groups, the older the woman the higher the prevalence of contraceptive use. Nonpregnant married women with higher education and number of children present higher percentage of contraceptive use than their counterparts, respectively. With regard to age at first marriage, results from Table 1 shows that 31% of nonpregnant married women who married before turning 15 was currently using contraception in 2010. This share is lower when compared to those from women who married at older ages.
5 Table 1 - Percent distribution of currently nonpregnant married women age 15-49 by use of contraception according to selected variables. Afghanistan, 2010. Variables Currently using contraception (%) Total Age Groups 15-19 0.14 1,319 20-24 0.22 3,919 25-29 0.28 4,173 30-34 0.32 3,308 35-39 0.34 3,433 40-44 0.30 2,843 45-49 0.22 2,313
Type of region Rural 0.23 14,801
Urban 0.43 6,507
Age at first marriage
<15 0.31 4,633 15-17 0.27 7,464 18-19 0.25 4,422 20 or more 0.24 4,789 Education No Education 0.25 18,351 Primary 0.42 1,371 Madrassa 0.33 332 Secondary 0.47 1,041 Higher 0.52 214 Parity (number of children) Zero 0.01 1,666 1 to 2 0.21 4,429 3 to 4 0.29 4,771 5 or more 0.32 10,443 Total 0.27 21,308 Source: AMS. 2010
Next, Table 2 presents the odds ratios of factors associated with the current use of contraception among nonpregnant married women age 15-49 in Afghanistan in 2010. Nonpregnant married women who married at younger ages have a higher chance of using contraception than those who married latter, especially when compared to those who married at age 20 or older. This finding does not support the hypothesis that women who have an earlier marriage are less likely to use contraceptive methods. One possible explanation is that women who postpone marriage in Afghanistan (at age 20 or more) are less likely to avoid pregnancies because their “delay”, which is not culturally expected, relatively reduce their exposure time to childbearing.
6 Table 2 - Odds Ratio of factors associated with the current use of
contraception among nonpregnant married women age 15-49 . Afghanistan. 2010.
Variables Odds Ratio
Age Groups 15-19 1.00 20-24 0.94 25-29 0.91 30-34 0.88 35-39 0.90 40-44 0.76** 45-49 0.50***
Type of region Rural 1.00
Urban 2.07***
Age at first marriage
<15 1.00 15-17 0.93* 18-19 0.90** 20 or more 0.86** Education No Education 1.00 Primary 1.98*** Madrassa 1.54** Secondary 2.54*** Higher 2.92*** Parity (number of children) Zero 1.00 1 to 2 18.1*** 3 to 4 30.4*** 5 or more 39.7*** Total 21,308 Source: AMS. 2010 *P<0.1 **P<0.05 ***P<0.01
Certainly, children are highly valued in Afghanistan. Among other reasons, a successful marriage depends on the number of children, especially boys, a woman has. More specifically, woman’s status in the family depends on the number of children she has and failure to conceive is a legitimate reason for a husband to demand divorce (The World Bank, 2005).
7 References
Afghan Public Health Institute. Ministry of Public Health (APHI/MoPH) [Afghanistan]. Central Statistics Organization (CSO) [Afghanistan]. ICF Macro. Indian Institute of Health Management Research (IIHMR) [India]. and World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO) [Egypt]. 2011. Afghanistan Mortality Survey 2010. Calverton. Maryland. USA: APHI/MoPH. CSO. ICF Macro. IIHMR and WHO/EMRO.
Dahl. G. (2010). Early Teen Marriage and Future Poverty. Demography 47( 3): 689-718.
Jensen. R. Thornton. R. (2003). Early female marriage in the developing world. Gender
and Development 11( 2): 9-19.
Singh, S. & Samara, R. (1996). Early marriage among women in developing
countries. International Family Planning Perspectives 22 (4):148-157
The World Bank (2005). Afghanistan National Reconstruction and Poverty Reduction — the Role of Women in Afghanistan’s Future.
