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Marital and Fertility Decision-Making

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Marital and Fertility Decision-Making Marital and Fertility Decision-making The Lived Experiences of Adolescents and Young Married Couples in Andhra Pradesh and Telangana, India Gina Crivello, Jennifer Roest, Uma Vennam, Renu Singh and Frances Winter The authors Gina Crivello is an anthropologist and Senior Researcher in the Department of International Development at the University of Oxford, where she leads Young Lives’ qualitative longitudinal research and its gender, adolescence and youth research theme. With a particular interest in age, gender and generation, Gina’s research has focused on children and young people’s everyday experiences of poverty, migration and mobility, productive and reproductive roles in family life, and gendered transitions to adulthood. She is the Young Lives Principal Investigator on a new comparative study of young marriage and parenthood in Ethiopia, India, Peru and Zambia. Jennifer Roest is a Wellcome Trust Research Fellow in Ethics and Maternal and Child Health at the Ethox Centre, University of Oxford. She currently acts as a qualitative researcher for REACH – a project looking at resilience, empowerment and advocacy in Women’s and Children’s Health Research in Kenya, South Africa and Thailand (funded by the Wellcome Trust Collaborative Award). Prior to this, Jennifer worked as Qualitative Research Assistant for Young Lives on themes of gender, inequality, youth and adolescence. Uma Vennam is a Professor of Social Work and the Pro Vice Chancellor at Sri Padmavathi Women’s University, Tirupati, India. She was trained at the Tata Institute of Social Sciences, Mumbai, and the University of East Anglia, UK. Her main research topics have been rural poverty, NGOs and rural development, and children in difficult situations (including trafficking). Uma is currently the Lead Qualitative Researcher for Young Lives India. Frances Winter is a Policy Officer at Young Lives, leading on policy work on gender and youth. She has worked on gender, equality and children’s rights internationally and in the UK for more than 20 years. She has a Masters in Social Policy and Planning in Developing Countries from the London School of Economics. Renu Singh has over 25 years’ experience in teaching, teacher education, education policy analysis and research, both in India and abroad. Her research interests are early childhood development, teacher education, inclusion and gender. She has held a number of prestigious positions at NGOs, including Save the Children, and in university departments. She has also advised the Indian Government by serving in a variety of working groups, joint review missions and on committees and boards such as Central Board of Secondary Education. She is the Country Director of Young Lives India. Acknowledgements We wish to thank the young people, families and communities for generously giving us their time and cooperation to undertake this study. We are very grateful to the team of qualitative researchers, Prof K. Anuradha, Ms M. Madhavilatha and Dr B. Geethanjali, and their assistants from Sri Padmavati Mahila Visvavidyalayam (Women’s University) in Tirupati who skilfully and sensitively carried out the interviews upon which this report is based. We are very grateful to Sudeshna Sengupta for writing the policy brief based on this report. In Oxford, Kristine Briones provided excellent quantitative research assistance. The authors would also like to thank Garth Stewart for design, Adam Houlbrook for copy-editing, and Anastasia Bow-Bertrand for her oversight of the production of this report. Young Lives is a collaborative partnership between research institutes, universities and NGOs in the four study countries and the University of Oxford. Young Lives has been core-funded by the UK Department for International Development (DFID). The Children’s Investment Fund Foundation provided funding to undertake this qualitative study on marital and fertility decision-making among married adolescent girls and young couples in India. The views expressed are those of the authors. They are not necessarily those of, or endorsed by, Young Lives, the University of Oxford, DFID or other funders. © Young Lives, June 2018 ISBN 978-1-912485-11-6 Suggested citation Crivello, G., J. Roest, U. Vennam, R. Singh, and F. Winter (2018) ‘Marital and Fertility Decision-making: The Lived Experiences of Adolescents and Young Married Couples Core-funded by in Andhra Pradesh and Telangana, India’, Research Report, Oxford: Young Lives. Photo credits The images throughout our publications are of children living in circumstances and communities similar to the children within our study sample. © Young Lives 2018. Marital and Fertility Decision-making Page 3 Research highlights • Adolescent girls continue to have limited choice in who and when they marry. • Sex education in schools is failing young people. • Adolescent girls and their spouses enter marital life with limited knowledge about modern contraceptive choices. • Although contraceptive options are available, they are not reaching the young married couples who want or need them. • Contraceptive use is very low among young married couples. • Sterilisation of women in their early twenties is common after they have had children. • Boys and young men are marginalised from sexual and reproductive health services. • Although girls who marry in early adolescence are particularly vulnerable, marrying over the age of 18 does not guarantee improved freedoms and choice in marital and fertility decision-making. Page 4 Marital and Fertility Decision-making Contents The authors 2 Acknowledgements 2 Executive summary 6 Part One: Introduction and background 10 1. Introduction 11 1.1. Organisation of this report 11 2. Background 12 2.1. Adolescent pregnancy and childbirth are major global health concerns 12 2.2. Child marriage and young married couples 12 2.3. The Indian context 13 2.4. Andhra Pradesh and Telangana 13 3. Policy and legal context 14 3.1. Law 14 3.2. Policy 14 3.3. Programmes 15 Part Two: Study design and context 17 4. Young Lives and current study 18 4.1. Young Lives 18 4.2. Current study 19 4.3. Young Lives survey: patterns of adolescent marriage and fertility 23 Part Three: Qualitative findings – the lived experiences of adolescent girls and married young couples 27 5. Life before and leading up to marriage 28 5.1. Unmarried adolescent engagement with sexual and reproductive health services and information 28 5.2. Marital decision-making 30 5.3. Transition to the marital household: becoming a wife and daughter-in-law 37 6. Young married couples: physical intimacy and fertility trajectories over time 44 6.1. ‘The first night’ – vulnerability and fear 45 6.2. Factors influencing the timing of couple’s first sexual encounter 46 6.3. Sexual and reproductive health information and services in the transition to marital life 49 6.4. Contraceptive knowledge 51 6.5. Contraceptive use and limitations 52 6.6. Factors affecting decisions around the timing and delay of the first pregnancy 53 6.7. Barriers to informed fertility decision-making in the early years of marital life 59 Marital and Fertility Decision-making Page 5 7. Fertility preferences and efforts to influence fertility outcomes over time: birthing gaps, sterilisation and abortion 66 7.1. Birth spacing 66 7.2. Strong preference for two children, ideally one girl and one boy, followed swiftly by sterilisation 70 7.3. ‘Fertility scripts’ – a typical trajectory 72 7.4. Sterilisation – ‘surely, operation’ 72 7.5. Abortion and managing unwanted pregnancies 74 7.6. Facing difficulties to conceive 79 Part Four 82 8. Conclusions 83 Endnotes 87 References 89 Appendices 92 Appendix A: Interview topic guide by respondent group and interview type 92 Appendix B: Key attributes of married female research participants (by site) 93 Page 6 Marital and Fertility Decision-making Executive summary Adolescent girls continue to have little say in who and when they marry or the timing of their sexual debut. Even after marrying, other people garner considerable authority over young women’s bodies, roles and reproductive trajectories. Major decisions affecting their reproductive health and trajectories are made by, in consultation with, or in consideration of significant others in their lives – their husbands, in-laws, natal families and health workers – and in light of the perceived role of destiny in determining fertility fates. Improved access to schooling is not translating to improved reproductive choice. Girls alone will not shift the entrenched norms and economic conditions that contribute to their social marginalisation. Strategies must include girls and boys, their families, other gatekeepers, and their wider communities. Girls and women’s social value needs to be broadened beyond their roles as wives, mothers and mothers-in-law. One in three girls married in childhood worldwide live in India.1 The timing of childbearing is linked to the timing of marriage, so that marrying young increases the likelihood of early childbearing.2 In India, as elsewhere, the main focus is on the prevention and delay of girls’ marriage under the age of 18. India’s government has a long history of legislating, policymaking, and programme development to affect and improve child marriage and adolescent sexual and reproductive health (SRH) outcomes. However, the pace of change is slow. Much less attention is directed toward understanding the everyday lives of adolescent married girls in the early phases of marital life, including their capacity to negotiate decisions affecting
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