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ORIGINAL ARTICLE
Year : 2022  |  Volume : 25  |  Issue : 7  |  Page : 1173-1179

The views of adult married women living in villages on early marriage and its relation with the perception of health


1 Department of Nursing, Bitlis Eren University, Turkey
2 Department of Health Care Services, Yozgat Bozok University, Turkey

Date of Submission08-Nov-2021
Date of Acceptance12-May-2022
Date of Web Publication20-Jul-2022

Correspondence Address:
Dr. C Onen
Department of Nursing, School of Health, Bitlis Eren University, Bitlis, 13000, TR
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_1930_21

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   Abstract 


Background/Aim: Early marriage is a preventable public health problem that brings along social and health problems as well. This study was performed to determine the views of adult married women, who live in the villages located in the central district of Bitlis which is situated in the eastern region of Turkey, on early marriage and compare their views with their perception of health. Subjects and Methods: Adult married women, who live in the villages located in the central district of Bitlis which is situated in the eastern region of Turkey, constitute the population of this cross-sectional study. Results: Customs and traditions, helping with household chores or agricultural tasks, and bride price are the main factors in preferring these marriages. It has been determined that age (r = 0.100; P = 0.047) and number of children (r = 0.153; P = 0.002) are positively related with health perception, albeit weakly. The median (score: 49) of women having five or more children is significantly higher than women (score: 45) with children in the range of 0-2. Conclusion: Women living in rural areas have a high rate of early marriage, and traditions and customs determine the decision to marry. Age and number of children were found to be positively correlated with perception of health, though weakly. Increasing the perception of health before and during the initial years of marriage could help in preventing many adverse effects that are caused by early marriage. With the increase in age and number of children, women might seek more health. This can increase women's health perception.

Keywords: Early marriage, perception of health, public health, traditions


How to cite this article:
Onen C, Ocal N U. The views of adult married women living in villages on early marriage and its relation with the perception of health. Niger J Clin Pract 2022;25:1173-9

How to cite this URL:
Onen C, Ocal N U. The views of adult married women living in villages on early marriage and its relation with the perception of health. Niger J Clin Pract [serial online] 2022 [cited 2022 Aug 19];25:1173-9. Available from: https://www.njcponline.com/text.asp?2022/25/7/1173/351465




   Introduction Top


Early marriage is a social problem on which it is agreed upon in many countries today. As stated in the United Nations Convention on the Rights of the Child, every human being up to the age of eighteen is considered a child, except that the law provides for the early age of consent.[1] Marriages under the age of 18 are called early marriage or child marriage, and the girl who gets married is called a child bride.[2],[3] It is more common among girls to marry someone older than them. For instance, in Mauritania and Nigeria, more than half of the married girls between the ages of 15-19 have husbands aged 10 years older than them.[4] Sub-Saharan Africa is one of the regions across the world where early marriage is very common.[5]

It is not possible for the child to reach full physical, psychological, and physiological maturity. Individuals at this age also face serious problems in taking responsibilities such as marriage and childbearing before completing their own development.[4] Early marriage is a violation of human rights, it jeopardizes physical and mental well-being and increases social disadvantage for girls.[6],[7] The majority of these marriages, which are experienced before completing their psychosocial and physical development, are called early and forced marriages as they take place without the consent of the child. Since child brides are known as individuals who are not free and do not have the ability to give full consent, this situation is considered a violation of rights as well as abuse.[2],[8],[9],[10],[11]

The reasons for early marriage can be listed as follows: Lack of education and the socioeconomic level of the family, traditions and religious beliefs, being exposed to harassment and rape, traditional judgments and social pressure of the family, gender inequality, domestic violence, natural disasters and wars, and other reasons.[12]

One of the important factors that pave the way for early marriages is the low education level of families. It is well-known that early marriages are more common among families with low levels of education and income. While the marriage of boys depends on having the minimum level of education and fulfilling military duty, girls do not need to have the education to marry, as the family's limited income is spent on the education of the boy. Thus, girls get engaged right after they start adolescence and then get married.[12],[13]

From the perspective of traditional and religious beliefs, it is possible to state that this situation occurs particularly in societies with patriarchal family structures and with misinterpretation and misdirection of religion. Early marriages occur also due to the belief of the parents that they protect the honor of their girls as well as their desire to ensure their daughters' honor before the family pass away. Families think that by marrying their daughters at an early age, the likelihood of harassment or abuse from outside will also disappear. Moreover, it is also a common thought among families that by marrying their daughters at an early age, they will prevent extramarital intercourse with the opposite sex and becoming pregnant.[3],[13]

When examined in terms of gender inequality, inequalities between males and females are experienced in patriarchal societies and as a result of their guidance. The meanings and values attributed to male and female gender play a role in the basis of gender inequality. Being more tolerant of boys in terms of both education and the use of financial means, the fact that boys are more prioritized on these issues, and the concept of honor associated with girls are among the remarkable issues regarding gender inequality.[13]

Domestic violence is also an important issue among the reasons for early marriage. Due to domestic violence, having to live with non-self parents, loss of mother or father at an early age, experiencing domestic conflicts, and many similar reasons the girl's desire to avoid these difficulties and prefer marriage as salvation at an early age is also among the reasons for marriage. Another striking issue is that girls are forced to marry their rapists, which is among the reasons for early marriage.[3],[11],[14]

Perception of health includes “the emotions, feelings, thoughts, and expectations of the individual related to his/her health.[15] It focuses on the control center, self-awareness, precision, and the cruciality of health. This study was performed to assess the perception of married women living in villages about early marriage and to compare it with the perception of health.


   Materials and Methods Top


Scope of the research

Adult married women, who live in the villages located in the central district of Bitlis which is situated in the eastern region of Turkey, constitute the population of this cross-sectional study. 400 married women were surveyed voluntarily between March 15, 2019, and May 25, 2019.

Data collection and evaluation

Personal Information Form and Perception of Health Scale' were used to collect data. Personal Information Form, which was prepared by researchers through literature review, consists of 19 questions about socio-demographic characteristics of women and their views about early marriage. Perception of Health Scale consists of 15 questions in total and the answers are in 5-point Likert type. The scale was developed by Diamond et al.[16] in 2007. Positive statements in the scale were scored as “strongly agree (5)”, “agree (4)”, “neutral (3)”, “disagree (2)”, “strongly disagree (1)”. Negative statements were scored as “strongly agree (1)”, “agree (2)”, “neutral (3)”, “disagree (4)”, “strongly disagree (5)”.

The scale has four sub-factors. These sub-factors are as follows; “Control Center”, “Self Awareness”, “Certainty”, “The Importance of Health”. Negative statements on the scale are scored reversely. Queries 1, 5, 9, 10, 11, and 14 are positive, and queries 2, 3, 4, 6, 7, 8, 12, 13, and 15 are negative statements. The lowest score that can be obtained from the scale is 15, and the highest score is 75. The Turkish validity and reliability study of the scale was performed by Kadıoğlu and Yildiz in 2011. In the validity and reliability study of Kadıoğlu et al.,[17] the Cronbach's Alpha coefficient was determined to be 0.77 in the nursing group with high reliability.

Statistical analysis

Number, percentage, mean, minimum and maximum, ratio, and frequency values were used in descriptive statistics in the analysis of the data. The distribution of the variables was analyzed via the Kolmogorov-Smirnov test. Spearman correlation analysis, Mann-Whitney U, and Kruskal Wallis-H tests were used in the analysis of quantitative data. Results are expressed as mean ± standard deviation, median (min-max), and percentage. The results were considered statistically significant at P < 0.05. The software of SPSS 22.0 was used in the analysis of the data.

Ethics of study

To perform the study, ethical approval was obtained from Bitlis Eren University Ethical Principles and Ethics Committee (Decision No: 2019/02-II-III, Meeting Date: February 21th, 2019).


   Results Top


A total of 400 adult married women were included in the study. When the sociodemographic characteristics of the women are analyzed, it was determined that the majority of women, 68.5%, were married at an early age. Moreover, 50.3% of the participants were aged between 31 and 50 years, 49.7% were illiterate, and 53% had five or more children [Table 1].
Table 1: Distribution of socio-demographic characteristics and comparison of health perception

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When the socio-demographic characteristics of women and their perception of health scores were compared, it was determined that there was no significant difference between the age range, age of marriage, literacy status, and health perception score, whereas there was a significant difference between the number of children and perception of health score (P < 0.05).

In the early marriage of women, traditions and customs (64.7%) take the first place, and help with household or agricultural work (39.2%) takes the second place. Other results regarding early marriage are presented in [Table 2]. A significant difference was determined between the participants' health perception scores and early marriages of them due to the fact that they help with their household chores and agricultural tasks as well as their early marriage due to a large number of siblings (p < 0.05).
Table 2: Determinants of early marriage and perception of health score comparison

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As shown in [Table 3], the views of the participants on marriage are presented and compared with their perception of health scores. About 18.7% of the women stated that they quit their education due to marriage, 54.8% stated that their parents were effective in the decision to marry, while 47.5% had a consanguineous marriage, and 5.5% considered early marriage healthy.
Table 3: Comparison of views on early marriage and perception of health score

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When the views of the women about marriage and health perception scores were compared, it was found that there was a significant difference between dropping out of school due to marriage, the factor impacting marriage, the status of consanguineous marriage, and the perception of health (P < 0.05).

About 77.2% of adult married women did not attend Mother and Child Health (MCH) centers, and 87.8% did not receive counseling on family planning [Table 4].
Table 4: Participants' status of applying to MCH and receiving consultancy

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The health perception scale mean score of the participants in the study was determined as 47.74 ± 5.15. When the mean scores obtained from the sub-dimensions of the health perception scale were examined, it was determined that the “control center” sub-dimension had the highest mean score with 14.67 ± 3.67 points, and it was followed by sub-dimensions of “acuity” with 13.22 ± 2.19 points, the “importance of health” with 10.29 points ± 2.51 points and the “self-awareness” sub-dimension with 9.54 ± 1.73 points, respectively [Table 5].
Table 5: Mean score of participants' perception of health scale and sub-factors

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When the correlation between age and health perception scale score is examined and shown in [Table 6], it is seen that there is a statistically weak and significant positive correlation. When the correlation between the participants' number of children and the score of the Perception of Health Scale was examined, it was found that there was a statistically positive, weak, and significant correlation.
Table 6: The correlation between some characteristics of participants and the perception of health

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   Discussion Top


Nearly half of the women in the study were illiterate and had to drop out of their school due to early marriage. The majority of them stated that they had to marry at an early age due to customs and traditions. Helping with household chores and agricultural tasks, directive of family elders, consanguineous marriage, bride price, and social pressure were the main socio-economic variables determining women's early marriage in this study. There are studies in the literature about the relationship between tradition and education. It has been revealed that low levels of education, inability to access education and traditional social structure are among the reasons for early marriage.[18] The expectation of the society and the family on women due to the traditional structure hinders women to have an education. Evidence that early marriage could lead to sociological, economic, and educational setbacks is widespread.[19],[20],[21]

In this study, women are predominantly unaware of the problems that might be caused by early marriage. Early marriage can bring along many physical and psychological problems. Findings are indicating that girls who get married at an early age experience bleeding, anemia, and difficult births.[22] Low gestational age is associated with an increase in obstetric and perinatal complications.[23] Furthermore, the mental risk is higher among those who get married at an early age than in adults. In addition to the higher frequency of depression, somatization, anxiety, and spousal violence, psychiatric therapy needs are higher compared to adults.[24] Within this context, health education and foster family planning studies are needed. Considering the statements of women, it is noticed that their status of receiving health education and family planning counseling is remarkably low. Providing health education, particularly for adolescents makes a significant contribution to the protection from risky behaviors.[25],[26]

As can be seen from the previous studies in the literature, numerous problems are arising from early marriage. The attitudes of women play a key role in breaking this vicious circle. Few of the women, 6.5% of them, have a positive attitude regarding their daughter's early marriage. It is seen that this view is less common, with a rate of 1.9%, among female university students.[27] This difference might be due to the education level. Albeit the attitude of women is important, it is noticed that it is not the sole determinative factor. A few years after menarche, girls are considered ready for marriage by their social circle and can be married without considering their consent.[28] In this study, for the majority of women, the social environment was determinant in their marriage. Hence, in solving the problem, improvements for women and their social environment should be implemented together.

The perception of health is related to the gaining of healthy living behavior through education and the improvement of health. Providing health education to adolescents would contribute to preventing risky behaviors such as early marriage and developing a positive perception of health.[25] Managing physical activity and leisure time activities could also enhance the perception of health.[29] In this study, a significant difference was determined between the perception of health and women's dropping out of school, helping with household chores and agricultural tasks, having a large number of siblings, who have a say in marriage, as well as consanguineous marriage. Further studies are needed to reveal the relationship between these situations, which also carry clues about the status of women and early marriage.

In this study, the health perception score of women was determined to be 47.74; whereas the self-awareness score of the health perception subcomponents of women was low, the score of the control center was high. Considering the literature studies on general health perception, it is noticed that the score ranges between 39.84 and 51.86.[30],[31],[32],[33] These differences in perception of health might be since the study was performed on women, as well as on sociodemographic characteristics, education, and life in rural areas. Besides, a weak positive significant correlation was determined between the perception of health and “women with many children” and age. In the study conducted by Uysal and Ünal Toprak in 2022,[34] it was determined that there was no statistically significant relationship between total scores of age and health perception and the sub-dimension scores (r = -0.103; P = 0.105). In the study conducted by Şengül,[35] a statistically significant difference was ascertained between the health perception levels of individuals and their age. The health perceptions of the participants in the age group of 19-39 and the older participants were found to be higher. In another study, it was stated that perceived health would decrease with increasing age.[36] It is observed that health perception changes according to age and different socioeconomic statuses. The health experiences gained with age and having many children and their educational potential might have changed the health perception of women.


   Conclusion Top


Women living in rural areas have a higher rate of early marriage, and customs and traditions determine the decision to marry. Women are generally not determinative in marriage, and parents and society are determinants. Age and number of children were found to be positively correlated with perception of health, though weakly. With the increase in age and number of children, the women can lead to more health seeking. In this case, the women's perception of health may increase. The prevalence of early marriage and consanguineous marriage is a negative situation for women's health. Enhancement of the perception of health before and in the early stages of marriage at an early age might be more advantageous in preventing problems caused by early marriage. Despite all these, women's counseling and education needs could not be met sufficiently.

As the study was performed in a rural area, it is not possible to generalize the results of early marriage to all women. However, it is expected to contribute to the literature in the context of early marriage and health perception. Moreover, since early marriage has negative reflections on numerous issues, further studies are needed on the subject.

Acknowledgements

We would like to express our gratitude to Nuh YALÇIN, Hamza TOK, Mustafa Emin YALCIN and Behiye ATAY for their contribution in collecting the data of the survey.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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