Survey of married adolescent girls in rural Upper Egypt: A collaborative study with Assiut University Nahla Abdel-Tawab American University in Cairo/ Social Research Center June 18-19, 2014

Acknowledgements Dr. Omaima El-Gibaly and Department of Community Medicine, Assiut University Dr. Montasser Kamal and Ford Foundation Dr. Doaa Oraby and PC /Egypt team

 Phase 1: individual researchers from 8 institutions  Phase 2: groups of researchers from 2-3 institutions  Phase 3: working with one institution to establish a center of excellence in youth SRH Building capacity of researchers in youth SRH

Why a survey of Married Adolescent Girls (MAGs)?  16% of adolescent girls years are either married or engaged (SYPE, 2010)  MAGs are prone to poor SRH outcomes:  Early and closely spaced pregnancies  Complications during pregnancy and childbirth  Sexually transmitted Infections  Intimate partner violence

Why a survey of MAGs?  Very little is known about SRH needs of MAGs or their health- seeking behavior  Most of the evidence derived from small scale qualitative studies or research conducted in South East Asia or sub-Saharan Africa  Most programs geared towards prevention of early marriage

Study objectives Provide estimates of key sexual and reproductive health indicators among MAGs in rural Upper Egypt; Measure the extent of MAG exposure to various forms of IPV; Assess key contextual, attitudinal and cognitive factors that could mitigate effects of early marriage on girls’ SRH Provide policy recommendations and identify opportunities for interventions

Study methodology  Descriptive cross sectional survey  Four districts in Assiut and Sohag  Sample of 990 MAGs under age 20 (married for at least three months) selected from eight villages  Households that include MWRA will be selected at random using EDHS 2014 sampling frame  Study instruments  Roster of household members  MAG’s questionnaire

MAG’s Questionnaire Divided into 10 sections 1.Socio-demographic characteristics 2.RH knowledge 3.Social support 4.Access to SRH services 5.RH seeking behavior 6.Reproductive history 7.Engagement and marital relations 8.Social network, mobility and resources 9.Exposure to IPV 10.Suggestions for intervention

Procedures for protection of human subjects Protocols reviewed and approved by PC and Assiut University Ethics Committees Informed consent will be obtained from MAG and guardian Data collectors will be adequately trained in handling sensitive questions Participation is completely voluntary Interview will be stopped if participant experiences emotional distress Precautions will be taken for protection of confidentialty of information provided by MAGs

Potential challenges  Obtaining CAPMAS clearance  Guardian denying presence of MAG / refusing her participation  Finding a private spot for interview  Handling cases of severe forms of IPV or emotional distress

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Men and gender based violence 36% of MWRA experienced any form of physical, emotional or sexual violence by their current or most recent husband 38% of young men years believe a husband is justified in beating his wife if she refuses to have sex with him 42% of young men believe ‘wasting his money’ is a good reason for beating wife

Men and FGM (EDHS, 2008 & SYPE, 2011)  91 % of married women aged years and 76% of girls have been circumcised.  41 % of women indicted that their husband believed FGM should continue.  More than half of girls were circumcised by medical personnel.  More young men than women years believed FGM was a necessary practice (70% vs. 58%).

Men and HIV infection  40 of infected individuals are women  Marriage is the number 1 risk factor for women  Biologically women are 5 times more vulnerable than men  Socio-cultural factors increase women’s vulnerability to HIV

How can men be involved in RH? RH services for men Counseling men about RH needs of women Brochures and fliers for reaching husbands Mass media School curricula for reaching young men

Counseling men about RH needs of women Assign special hours for men to accompany their wives to the clinic Train health providers in joint counseling techniques Counseling men should never be a substitute for counseling women about their own health.

THANK YOU