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OBJECTIVE: Child marriage forces a girl into adult roles before physical and psychological maturity, which can take a toll on women's health over the life course. This article aims to assess whether child marriage and adolescent childbearing are associated with elevated risk of gynaecologic disorders leading to hysterectomy. DESIGN: Cross-sectional and time-to-event analysis. SETTING: India. POPULATION: 528 816 ever-married women, aged 20-49 years. METHODS: Women were grouped in four mutually exclusive categories: (i) married adult-not an adolescent mother (reference category), (ii) married adult-adolescent mother, (iii) married child-not an adolescent mother and (iv) married child-adolescent mother. Multivariable logistic regressions were fitted to assess the odds of hysterectomy for these groups. Nonparametric Kaplan-Meier survivor functions were estimated to evaluate survival rates across the groups. MAIN OUTCOME MEASURES: Whether had a hysterectomy and age when hysterectomy was performed. RESULTS: Compared to women married as adults, not an adolescent mother, women married in childhood and gave birth in adolescence were 1.87 (95% CI: 1.78-1.96) times more likely to have a hysterectomy. The latter group also had the lowest survival probability for hysterectomy at all ages (e.g., 85.80% [95% CI: 85.41-86.18] at age 49 years as compared to 91.65% [95% CI: 91.37-91.89] for the former group). Women married as children but not adolescent mothers and married as an adult but gave birth in adolescence also had higher odds of hysterectomy-1.40 (95% CI: 1.31-1.50) and 1.53 (95% CI: 1.40-1.66) times of that of the reference group, respectively. CONCLUSIONS: Our results, showing a strong relationship between child marriage and hysterectomy, contribute to the literature on later-life health consequences of child marriage.

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Child marriage has a significant health impact on young mothers and their offspring. This study aims to compare the effectiveness of the Jalinan Kasih Android-based application, the Marriage Age Maturity (PUP) module, and the lecture method in improving knowledge, attitude, and practice regarding early marriage among high school students. A quasi-experiment with control groups was conducted, involving 72 students selected from three high schools in Bengkulu City, Indonesia who met the inclusion criteria. The participants were divided into three groups: 24 individuals in the application intervention group, 24 individuals in the module intervention group, and 24 individuals in the control group. The Jalinan Kasih application group showed an increase in average scores before and after the intervention, in terms of knowledge (6.46), attitude (6.79) and practice (1.75), with a p-value of 0.000, 0.000 and 0.17, respectively, The Jalinan Kasih application had a greater influence on knowledge, attitude and practice compared to the PUP module and the lecture method with a p-value of 0.000. In other words, the Jalinan Kasih mobile application was effective in improving the knowledge, attitude, and practice of high school students regarding early marriage through the use of its contents and consultation feature. It is recommended that the Jalinan Kasih application be used as an educational medium to prevent early marriage and improves family planning.

Le mariage des enfants a un impact significatif sur la santé des jeunes mères et de leur progéniture. Cette étude vise à comparer l'efficacité de l'application basée sur Android Jalinan Kasih, du module Marriage Age Maturity (PUP) et de la méthode magistral pour améliorer les connaissances, l'attitude et la pratique concernant le mariage précoce chez les lycéens. Une quasi-expérience avec des groupes témoins a été menée, impliquant 72 étudiants sélectionnés dans trois lycées de la ville de Bengkulu, en Indonésie, qui répondaient aux critères d'inclusion. Les participants ont été divisés en trois groupes : 24 personnes dans le groupe d'intervention d'application, 24 personnes dans le groupe d'intervention du module et 24 personnes dans le groupe témoin. Le groupe d'application Jalinan Kasih a montré une augmentation des scores moyens avant et après l'intervention, en termes de connaissances (6,46), d'attitude (6,79) et de pratique (1,75), avec des valeurs p de 0,000, 0,000 et 0,17, respectivement. L'application Jalinan Kasih a eu une plus grande influence sur les connaissances, l'attitude et la pratique par rapport au module PUP et à la méthode magistral avec une valeur p de 0,000. En d'autres termes, l'application mobile Jalinan Kasih a été efficace pour améliorer les connaissances, l'attitude et la pratique des lycéens concernant le mariage précoce grâce à l'utilisation de son contenu et de sa fonction de consultation. Il est recommandé d'utiliser l'application Jalinan Kasih comme support pédagogique pour prévenir les mariages précoces et améliorer la planification familiale.

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INTRODUCTION: Child marriage, defined as marriage before the age of 18 years, is a precocious transition from adolescence to adulthood, which may take a long-term toll on health. AIM: This study aims to assess whether child marriage was associated with added risk of adverse cardiovascular outcomes in a nationally representative sample of Indian adults. METHODS: Applying the non-laboratory-based Framingham algorithm to data on 336,953 women aged 30-49 years and 49,617 men aged 30-54 years, we estimated individual's predicted heart age (PHA). Comparing the PHA with chronological age (CA), we categorized individuals in four groups: (i) low PHA: PHA < CA, (ii) equal PHA: PHA = CA (reference category), (iii) high PHA: PHA > CA by at most 4 years, and (iv) very high PHA: PHA > CA by 5 + years. We estimated multivariable multinomial logistic regressions to obtain relative risks of respective categories for the child marriage indicator. RESULTS: We found that women who were married in childhood had 1.06 (95% CI 1.01-1.10) and 1.22 (95% CI 1.16-1.27) times higher adjusted risks of having high and very high PHA, respectively, compared to women who were married as adults. For men, no differential risks were found between those who were married as children and as adults. These results were generally robust across various socioeconomic sub-groups. CONCLUSIONS: These findings add to the relatively new and evolving strand of literature that examines the role of child marriage on later life chronic health outcomes and provide important insights for public health policies aimed at improving women's health and wellbeing.

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BACKGROUND: Girl child marriage is increasingly recognized as a critical barrier to global public health and gender discrimination. There are still more gaps in the global rate of child marriage and the underlying factors. Thus, the present systematic review aimed to explore the prevalence of child marriage and the underlying factors. METHODS: A comprehensive search was conducted for all English-language studies that measured the prevalence of child marriage and its correlates from 2000 to March 2022, indexed in PubMed, Scopus, Web of Science, Poplin, and Google Scholar databases. Child marriage is defined as marriage under the age of 18. In the present study, Joanna Briggs' quality assessment checklist was used for data collection. Two independent reviewers reviewed all the articles. RESULTS: In total, 34 eligible prevalence articles and 14 trend articles were included in the study with data from 127,945 participants. The prevalence of child marriage ranged between 1.8% to 90.85%. In most studies, the trend of child marriage was decreasing. The most important individual factors include the respondent's education and occupation, interpersonal factors such as the education and occupation of parents and husband, family size and type. Community factors include socioeconomic status, region, residence, ethnicity, and religion at the social level. CONCLUSION: Despite a central focus of research and policies on interventions that decrease child marriage, this phenomenon is still prevalent in many places. Therefore, further specific interventions are required to improve education, reduce poverty and inequality. This may help achieve the 2030 Sustainable Development Goals.

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Early marriage is one of the most important social issues for young women and can have many consequences. The present study aimed to explore the consequences of early marriage among Kurdish women in western Iran who were married under the age of 18. This qualitative study was conducted with the approach of conventional content analysis. The data were collected through semi-structured interviews with 30 women selected by purposeful sampling. Data analysis was performed using Graneheim and Lundman's method. A total of 389 codes, 12 subcategories, 4 sub-categories, and 2 main categories were extracted from the data analysis. Negative consequences of early marriage include: 1-physical and psychological problems (high-risk pregnancy and childbirth, physical illnesses, depression, and emotional distress); 2-family problems (dissatisfaction with married life, experience of having lots of responsibility, lack of independence in family life); 3-social problems (risky social behaviors, lack of access to social and health services, social isolation, lack of access to a job, and educational opportunities); and 4-positive consequences, including receiving intra-family support, improving living conditions, and opportunities for progress and empowerment. It is possible to reduce problems and challenges after early marriage by increasing the awareness and knowledge of young women about contraceptives and providing appropriate social and health facilities, and services during pregnancy. Providing the necessary training and psychological counseling for them and their husbands on how to deal with personal problems and marital life will be effective to a great extent.

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OBJECTIVES: Child marriage is one of the most important challenges of the current era that threatens women's health and violates human rights. The present study aimed to systematically review studies evaluating the challenges and strategies to overcome child marriage. CONTENT: Medical databases (CINAHL, EMBASE, MEDLINE, EMBASE, PsycINFO, SCOPUS, Web of Science, ProQuest Nursing and Allied Health Source, and Social Science Research Network, as databases for English studies and IranMedex, Google Scholar, SID, Magiran, and Iran Doc as databases for Persian studies) were systematically searched from January 2010 to February 2020. To better identify appropriate studies, reference lists of relevant studies were searched. All potentially relevant abstracts and full-text were screened by two independent reviewers. Disagreements between two reviewers that could not be resolved were resolved via arbitration or consultation of a third author. SUMMARY AND OUTLOOK: From 225 articles included in this review, 16 research articles met our inclusion criteria. Most of the articles were dedicated to negative health outcomes related to child marriage. Ten studies addressed the program of overcoming the Child marriage and six studies reported challenges of it. Although, many studies have shown the efficacy of strategies to decline Child marriage. On the basis of the available evidence, it seems there are a number of obstacles to end Child marriage. To delineate the most effective strategy to end Child marriage is required further research.

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Background: Early childbirth is associated with adverse maternal and child health outcomes. In South Asia, where women generally marry before having children, public health efforts need to focus on delaying marriage. Female education is widely considered the primary means to achieve this. However, it remains unclear how much education is required to delay marriage to the universal minimum age of 18 years, or what predicts marriage age in women lacking any education. This is crucial to address in the Terai region of Nepal which has the highest proportion of children out of school and where girls marry and have their first pregnancy early. Methods: We analyzed data from 6,406 women aged 23-30 years from a cluster-randomized trial in lowland Terai Nepal. Using Kaplan-Meier survival analysis, multivariable logistic and Cox proportional hazards regression models, we investigated associations between women's education level and age at marriage and first pregnancy, and the interval between these events. Among the uneducated women, we investigated associations of husband's education level with the same outcomes. Results: Compared to uneducated women, educated women had a greater probability of delaying marriage until the age of 18 years and of pregnancy until 20 years. Women needed to complete grade 9, and ideally 11, to substantially increase their odds of marrying after 18 years. Delaying first pregnancy to 20 years was largely due to marrying later; education had little extra effect. The association of marriage with first pregnancy age worked independently of education. However, later-marrying women, who generally had completed more education, had their first pregnancy sooner after marriage than earlier marrying women. Most uneducated women, regardless of their husbands' level of education, still married under the legal age of marriage. Conclusion: Delaying marriage to majority age requires greater efforts to ensure girls get to school in the first place, and complete secondary education. Since currently only 36% of girls in the Terai attend secondary school, parallel efforts to delay marriage are crucial to prevent early childbearing. Sexual and reproductive health programmes in school and in women's groups for married and uneducated adolescents may help prepare for marriage and pregnancy.

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Marriage and related processes seem to show individual tendencies but are in fact social phenomena. The aim of this study was to identify, among women, trends in age at first marriage and its related factors. In this cross-sectional study, the target population was women in households in Fars Province, Iran. To identify main effects of variables associated with age at marriage, multiple linear regression modeling was used without interactions. Women's age, women's and their husbands' occupations and educational levels, and place of residence were included in multiple linear regression modeling. A total of 3074 ever-married women were interviewed. A steep upward trend over time in age marriage was observed. The mean age at first marriage was 16.9 ± 3.4 years in women who married during the period from 1954 to 1974, and 21.9 ± 4.1 years among those who married during 2005-2014. Age at first marriage was significantly positively associated with women's and men's educational levels and with husband's employment status as laborers (p = 0.017) and negatively associated with husbands being employees (compared to being unemployed) (p < 0.001). Health providers should focus on increasing public awareness of factors associated with early and with delayed marriage.

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The marriage of children below 18 is widely recognized in international human rights agreements as a discriminatory global practice that hinders the development and well-being of hundreds of millions of girls. Using a new global policy database, we analyze national legislation regarding minimum marriage age, exceptions permitting marriage at earlier ages, and gender disparities in laws. While our longitudinal data indicate improvements in frequencies of countries with legal provisions that prohibit marriage below the age of 18, important gaps remain in eliminating legal exceptions and gender discrimination.

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In many traditional societies, women's age at marriage acts simultaneously as a gateway to new family roles and the likelihood of producing offspring. However, inadequate attention has previously been given to the broader health and social implications of variability in women's marriage age for public health. Biomedical scientists have primarily been concerned with whether the onset of reproduction occurs before the woman is adequately able to nurture her offspring and maintain her own health. Social scientists have argued that early marriage prevents women from attaining their rightful education, accessing employment and training opportunities, developing social relationships with peers, and participating in civic life. The aim of this review article is to provide comprehensive research evidence on why women's marriage age, independent of age at first childbirth, is a crucial issue for public health. It focuses on data from four South Asian countries, Bangladesh, India, Nepal, and Pakistan, in which marriage is near universal and where a large proportion of women still marry below the United Nations prescribed minimum marriage age of 18 years. Using an integrative perspective, we provide a comprehensive synthesis of the physiological, bio-demographic, and socio-environmental drivers of variable marriage age. We describe the adverse health consequences to mothers and to their offspring of an early age at marriage and of childbearing, which include malnutrition and high rates of morbidity and mortality. We also highlight the complex association of marriage age, educational attainment, and low societal status of women, all of which generate major public health impact. Studies consistently find a public health dividend of increased girls' education for maternal and child nutritional status and health outcomes. Paradoxically, recent relative increases in girls' educational attainment across South Asia have had limited success in delaying marriage age. This evidence suggests that in order for public health initiatives to maximize the health of women and their offspring, they must first address the factors that shape the age at which women marry.

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It is important to understand the age at which sexual relations start in designing HIV prevention strategies. Most studies on age of sexual activity of young people provide estimated percentages of those that are sexually active in specific age groups, and tend either to not provide data for age at sexual debut, or to overlook the complexities of analysing data concerning sexual debut. This study considers the rate of entry into sexual relations in South Africa by providing the median age of women at time of first sexual relations as well as other percentiles, and analyses the hypothesis that age at sexual debut has been falling. The analysis uses data from the 1998 South African Demographic and Health Survey, including a nationally representative sample of 11 735 women, aged 15 to 49, interviewed in 1998. The analysis uses life-table techniques and multivariate analysis. About 8% of the respondents had had sex by age 15. The median age at time of first sex was approximately 18 years, and virtually all the women had had sex by age 23. There is evidence that the peak of the rate of entry into sexual relations occurs at age 18 and that younger cohorts of women are entering sexual relations at a younger age. The rate of entry into sexual relations is 14% to 20% faster for the younger cohorts, based on information given by the older respondents concerning their own behaviour at the same age. Age of entry into sexual relations of the women who participated in this study is compared to findings of demographic and health surveys in Tanzania and Zimbabwe, and rates of entry into marriage are also presented. The lag between entry into sexual relations and rate of entry into marriage is compared across countries. It appears that, whereas South Africans tend to enter into sexual relations later than Tanzanian counterparts and more or less at the same stage as Zimbabweans, their rates of entry into marriage are hugely delayed. The consequences for HIV infection control are discussed.

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Forty-five per cent of first marriages in Ethiopia end in divorce within 30 years, and two-thirds of women who divorce do so within the first 5 years of marriage. This paper looks at two factors that may have an impact on the risk of divorce in Ethiopia: early age of first marriage, and childlessness within the first marriage. Data used were from the 1990 National Family and Fertility Survey conducted by the Government of Ethiopia. A total of 8757 women of reproductive age (15-49) were analysed. Life table analysis was used to determine the median age at first marriage, first birth and the median duration of marriage. Cox models were analysed to determine the differentials of divorce. The results of this analysis showed that both early age at marriage and childlessness have a significant impact on the risk of divorce. An inverse relationship was found between age at marriage and risk of divorce. Having a child within the first marriage also significantly reduced the risk of divorce. In addition, several cultural and socioeconomic variables were significant predictors of divorce.

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PIP: This article presents the results of a multi-site study that aimed to clarify the reasons for the variations in the spread of HIV infection in sub-Saharan Africa. Behavioral and serological surveys of 1000 males and 1000 females were conducted in two high- and two low-prevalence locations. Results revealed that HIV infection and sexually transmitted diseases (STDs) were more prevalent among women than men, and were more pronounced among individuals aged 15-19 years in all sites. A high rate of sex partner exchange was observed in low-prevalence areas. High-prevalence areas had more girls who had their sexual debut before the age of 15, greater proportion of married people, and lower age at first marriage than low-prevalence areas. Among married teenage women in high-prevalence locations, higher age of husband was associated with greater risk of HIV infection. Meanwhile, condom use was low among men in all areas. Genital herpes (HSV-2) was more common in high-prevalence settings, and in all 4 locations HSV-2 was associated with increased risk of HIV infection. Male circumcision was almost universal in the low-prevalence areas, whereas only 10-30% of men in high-prevalence sites were circumcised. In a multivariate analysis, being circumcised was significantly linked to a lower risk of the infection. Overall, early sexual debut of females and age at first marriage of men, as well as STDs, were significantly associated to increasing risk of HIV infection. Efforts to reduce HIV infection should consider these factors.^ieng

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A study has been made of the probabilities of marriage of females and males aged 15-49 (either as a whole or in 5-year age groups) in two Outer Hebridean islands, Harris and Barra. The results were compared with ages of marriage and with the frequencies of permanent celibacy. The marriages took place between 1861 and 1990. Median ages of marriage rose to maxima in the 1930s and 1940s, then fell steeply, levelling out latterly. Permanent celibacy was consistently high among females, but rose from much lower levels in males to maxima in the 1970s and 1980s. It is concluded that in these populations age at marriage and the extent of permanent celibacy are largely independent of one another. In both islands the overall probabilities of females marrying fell until the 1920s, and then rose. The last decades showed stability (Barra) and a fall (Harris). Males showed only slight falls to about 1910; data were absent for between 1911 and 1960, but subsequently there was little rise in probability. These overall changes seemed to be associated with reciprocal variations in probabilities in the younger and older age groups. Declining overall probabilities were associated with declines in younger and increases in older age-group probabilities, and vice versa. Non-parametric correlations between median ages of marriage and probability of marriage were negative and generally significant for the 15-19 age group. Among the older age groups coefficients were generally positive. There was some evidence of an association between probability of marriage and sex ratio in any group of potential mates. The effect appeared more marked among 15- to 19-year-old females. Local factors which might explain at least part of the decline in nuptiality for the greater part of the period under study include the decline in the fishing industry and the 'land hunger' which existed until the late 1920s. This decline is interpreted as a 'Malthusian' response to economic and social conditions, but it coexisted with a 'neo-Malthusian' strategy, in the shape of declining marital fertility. The 'Malthusian' strategy seems to have been largely abandoned around the 1950s, but it may have reappeared during the 1980s.

PIP: This study examined the probability of marriage during 1861-1990 in two Outer Hebrides Islands (Harris and Barra). Data were obtained from marriage records in the General Register Office in Edinburgh, Scotland, and Census records. Barra Island is mainly Catholic. Harris Island is mainly Calvinistic Protestant. Short-term probabilities of marriage (POM) were calculated according to a modification of the methods of Pressat (1972). Findings indicate a gradual rise in marriage age that peaked in Harris during 1930-40 or 1941-50. Declines occurred until 1971-80. In Barra, declines continued until 1981-90. Permanent celibacy rose after 1861-80 and remained fairly constant at about 25-30%. After 1950, celibacy rose in Harris and remained constant in Barra. Male celibacy was under 10% until 1911-20, and then it rose to 20-30% after 1961. Celibacy rates were inversely related to marital ages until 1940. Short-term POM of females declined until 1920, especially in younger age groups, and then rose, especially during 1961-80 and among older ages, followed by stability in Barra and a decline in Harris. Males had higher POM than females prior to 1900 and then erratic patterns. Male POM did not rise after 1960. The relationship between POM and the sex ratio is unclear. The pattern of declining nuptiality until the 1940s contrasted with stable patterns in Scotland and England. Declines in nuptiality are attributed to economic hardship.

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The status of women, which is relative and multidimensional, has an important bearing on any long-term reduction in fertility. In Indian society, where cohabitation and childbearing are socially sanctioned only after marriage, the length of the first-birth interval affects the completed family size by influencing the spacing and childbearing pattern of a family. This study examines the influence of certain aspects of the status of married women--education, employment, role in family decision making, and age at marriage--along with three socioeconomic variables--per capita income of the family, social position of the household, and the caste system--on the duration of the first-birth interval in an urban Hindu society of the north-east Indian state of Assam. The data were analysed by applying life table and hazard regression techniques. The results indicate that a female's age at marriage, education, current age, role in decision making, and the per capita income of the household are the main covariates that strongly influence the length of the first-birth interval of Hindu females of urban Assam. Of all the covariates studied, a female's education appears to be a key mediating factor, through its influence on her probability of employment outside the home and thereby an earned income and on her role in family decision making. Unlike other Indian communities, the effect of the caste system does not have a significant effect on first-birth timing in this urban Hindu society.

PIP: This study examined determinants of first birth intervals (FBIs) among urban Hindu women in the northeastern state of Assam, India. Explanatory factors include women's status (education, employment, marriage age, role in family decision-making) and socioeconomic factors (family income, social position in the household, and caste). Data were obtained from a survey conducted in Guwati, the capital city of Assam, among 1650 eligible couples in 1991-92. Life table techniques and the guidelines of Rindfuss, Palmore, and Bumpass (1982) were followed to correct for censoring and sample selectivity. Analysis was based on Cox's hazard regression model. Findings indicate that mean age of marriage was about 21 years. Higher mean age at marriage was associated with education, wage earners, belonging to a higher monthly income group, having higher social status, and contributions to all household decisions. Marriage age varied more among low income groups, low status groups, those with little or no education, and those who do not take part in all household decisions. Life table techniques reveal that the median length of the FBI was under 16 months. Only 2% failed to give birth within 97 months of their marriage. In the full model with all 8 covariates, female occupation and position in the caste system did not have significant effects on FBI. Hazards of first births were higher when marriage age was under 17 years. Female education was negatively associated with first birth. Education delays marriage and increases the opportunity for paid employment.

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Fertility rates in Pakistan have remained consistently high over the past three decades. While numerous studies have examined sociodemographic determinants, the role of biological factors, and particularly consanguinity, has received little attention, even though marriage between close biological relatives continues to be the norm in Pakistan. Reproductive behaviour among women in consanguineous (first cousin) and non-consanguineous unions was compared, using data from a 1995 study of multi-ethnic communities in Karachi and the 1990-91 Pakistan Demographic & Health Survey (PDHS). The results show that, although female age at first marriage has been gradually rising in both study samples, women in consanguineous unions married at younger ages and were less likely to use modern contraceptive methods. In the Karachi sample, women in first cousin unions experienced a higher mean number of pregnancies and also reported a higher mean number of children ever born (CEB). However, their mean number of surviving children did not differ from those born to women in non-consanguineous unions, implying higher prenatal and/or postnatal losses in couples related as first cousins. On the other hand, the PDHS showed both lower CEB values for women in consanguineous marriages and a lower number of surviving children. Given the continuing popularity of consanguineous marriage, these findings have important implications for future fertility reduction in Pakistan.

PIP: This study examined fertility among women in consanguineous unions (CUs) in Pakistan and the association between CUs and contraceptive use and marriage age. Macrolevel data were obtained from the 1990 Demographic and Health Survey (DHS) among a subset of 4679 ever-married women. Microlevel data were obtained from a 1995 survey (KS) among a subset of 913 current married women from 4 squatter settlements in Karachi. Marriage age (MA) was 17.4 years in the KS and 17.8 years in the DHS. MA increased from oldest to younger cohorts in both samples. Female education was associated with the increase in MA. Urdu speakers had a much higher MA. Women in CUs had lower MA among all ethnic groups. 49.3% in the KS and 8.8% in the DHS reported current contraceptive use. Contraceptive use in the DHS differed significantly by marriage duration, child survival, and child mortality. Logistic models reveal that women in CUs in the KS were less likely to use contraceptives, after controlling for education. Both samples showed that contraceptive use was related to sex composition of surviving children and ethnicity. Women with only daughters were least likely to use. Place of residence was the strongest predictor of ever use. Duration of marriage was a significant predictor only in the DHS. Women in first cousin CUs in the KS had a higher mean children ever born (CEB) and number of pregnancies; DHS findings were the reverse. Multiple classification analysis showed in the KS that when sociodemography was controlled, CU was unrelated to mean CEB. DHS data showed CUs associated with reduced fertility. In both samples, mortality of children aged under 10 years had the most significant effect on CEB.

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91 young Ethiopian women who had developed total faecal incontinence from injuries sustained from sexual intercourse within marriage or rape were successfully treated at this hospital.

PIP: The article reports on the occurrence of postcoital injuries in 91 women treated at the Addis Ababa Fistula Hospital between 1991 and 1997. Among the 91 women, 78 had been sexually abused under the cover of marriage; 9 were kidnapped with the intention of marriage, raped, and then discarded by their would-be husbands; and 4 were kidnapped and raped. These Ethiopian women were victims of societal tradition which condone forced abduction and rape by men who cannot afford a wife, and a society where young girls were forced to perform domestic duties resulting to vesicovaginal fistula or rectovaginal fistula. Moreover, women who develop such injuries were usually perceived to have no further value as a wife. Of the 78 married women in the study who were injured, 59 were divorced and 19 were abandoned. Their total fecal incontinence means that these girls and young women were regarded as outcasts by society. In view of this, a need for a change in attitudes and behavior within traditional societies was considered. These changes would include education, amendment of policies and laws and interventions from the government and health workers.

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"The article compares publicly discussed norms concerning the proper age at marriage for men and women in nineteenth-century Netherlands, and the actual trends present in the empirical evidence about marriage age. Medical professionals (the hygienists) expressed the belief that marriage at too young an age was damaging both to public hygiene and the family's health; other commentators stressed the connection between young marriages and poverty. Yet such norms were put forward vaguely, allowing other influences on marriage age to come into play. Consequently, data on marital behavior suggest considerable diversity in the population, with age at marriage varying strongly by class, sex, and region. Generally, age at marriage did not begin to fall until the period 1860-1870, and even after that decade class differences remained strong."

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PIP: At the turn of the century, Taiwan's population was increasing slowly, then later grew during a period of high fertility after the end of World War II and the accordance of independence in 1946. This growth in fertility came together with increasing life expectancy and a general desire by couples to have families comprised of 5-6 children. Taiwan was therefore poised to experience a major population explosion. In this context, a family planning program was established in the country which has since evolved into one of the world's most successful such programs. By 1990, the preferred family size was 2-3 children and of couples which already had 2 children, 70% of those without any sons were nonetheless practicing contraception. While in 1965, no married women used contraception until they had some children, by 1990, 27% of married women without children used contraception. Increasing age at marriage has been an important factor in Taiwan's declining fertility, with the average age at marriage increasing from 20 years in the 1950s to approximately 27 in the 1970s. Few mothers, however, want only one child. The fertility trends observed in Taiwan have been made possible through the provision of contraception, which used to be universally free, but which is now provided free to only people of low income or the disabled. Oral contraception, condoms, and IUDs are used, although 30% of couples depend upon sterilization.^ieng

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OBJECTIVE: Although the recent spread of HIV/AIDS and other sexually transmitted diseases (STDs) in China has been associated with sexual activities, little information has been available about sexual behavior in rural areas with high HIV prevalence. Studies identifying high-risk sexual behaviors are needed to formulate effective prevention programs. METHODS: A cross-sectional study design was used to measure sexual activities using a two-stage cluster sampling method. A two-part anonymous questionnaire was used. Sensitive questions related to sexual behavior were administered using a tape recorder, earphones, and an answer sheet which did not include the text. RESULTS: In total, 1057 subjects were interviewed. Among 886 sexually active individuals, 7.8% had >1 sexual partner, 22.8% had premarital sex, 2.4% had anal intercourse, 4.1% had oral intercourse, and 2.3% had both anal and oral intercourse. Less than 2% reported past or current sexually transmitted diseases. Overall, 10.4% used condoms; only 11.2% for every sexual act. History of premarital and extramarital sex was higher in younger people. CONCLUSIONS: Sexual norms in rural China are changing rapidly and high-risk sexual behavior among young rural residents is increasing. Strategies to prevent HIV/AIDS should include education to promote delayed onset of sexual activity, safer sexual behavior, and condom use.

PIP: Little information has been collected about sexual practices in China's rural areas, where HIV/AIDS prevalence is increasing. A cross-sectional survey conducted in China's Anhui province in 1997 investigated the sexual histories of 1057 men and women 15-49 years of age, 878 (83%) of whom were married. Mean age at both marriage and first intercourse was 22 years for women and 23 years for men. However, mean age at first intercourse is declining over time while marriage age remains stable, providing greater opportunity for premarital sex. 22.8% of sexually active respondents--27.1% of men and 18.9% of women--acknowledged having premarital sex. For 94.9% of respondents, their first sexual partner was their spouse. 2.4% of respondents reported anal intercourse, 4.1% reported oral-genital intercourse, and 2.3% reported both practices. 1.7% of respondents had had a sexually transmitted disease and 7.8% reported more than one lifetime sexual partner. 68% of sexually active respondents reported contraceptive use, primarily condoms (10.4%). Among condom users, 11.9% used them for every sexual act, 30.5% used them only during ovulation, and 57.6% used them occasionally. Logistic regression analysis identified the following factors as significant predictors of high-risk sexual behaviors: younger age at first sexual intercourse, a desire to have multiple partners, more than two coital acts per week, exposure to pornography, higher income, and older age at marriage. These findings can be used in the design of HIV/AIDS prevention programs in rural China. Emphasis should be placed on delayed onset of sexual activity and consistent condom use.

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