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ORIGINAL ARTICLE
Year : 2017  |  Volume : 61  |  Issue : 1  |  Page : 26-32  

Awareness of legal and social issues related to reproductive health among adolescent girls in rural Varanasi


1 Professor, Department of Community Medicine, Institute of Medical Sciences, Varanasi, India
2 Assistant Professor, VKM College, Varanasi, India
3 Assistant Professor, Division of Biostatistics, Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

Date of Web Publication16-Feb-2017

Correspondence Address:
Alok Kumar
Department of Community Medicine, Division of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.200248

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   Abstract 

Background: Data on awareness of adolescent's on the legal and social issues/acts related to reproductive health, especially in rural areas, are scarce. Objectives: The aim of the present cross-sectional study is to assess the awareness level of legal and social issues related to reproductive health and its association with the various individual and family/household level characteristics. Methods: 650 adolescent girls in the age group of 15–19 years were interviewed with the help of pretested and semistructured questionnaire and focus group discussions were also conducted for qualitative findings in Chiraigaon block of district Varanasi. Results: It was observed that 42.9% of the respondents were aware of legal age of marriage, 14.9% knew about the right age of childbearing. Dowry prohibition act and domestic violence act were known to 46% and 27% respondents, respectively, and only 2.6% were aware of medical termination of pregnancy act. Logistic regression analysis shows the significant effect of education on awareness of legal age of marriage, right age of childbearing, domestic violence, and dowry prohibition acts, which is also supported by qualitative findings. Conclusion: All the important legal issues/acts should be included in high school curriculum and female teachers should be involved in training program for adolescents. Role of mass media in creating awareness about these issues in their routine programs should be ascertained. Accredited Social Health Activist and Anganwadi workers should be aware of and include these issues/acts in adolescent meetings.

Keywords: Awareness, domestic violence act, legal age of marriage, medical termination of pregnancy acts


How to cite this article:
Kansal S, Singh S, Kumar A. Awareness of legal and social issues related to reproductive health among adolescent girls in rural Varanasi. Indian J Public Health 2017;61:26-32

How to cite this URL:
Kansal S, Singh S, Kumar A. Awareness of legal and social issues related to reproductive health among adolescent girls in rural Varanasi. Indian J Public Health [serial online] 2017 [cited 2017 Mar 28];61:26-32. Available from: http://www.ijph.in/text.asp?2017/61/1/26/200248


   Introduction Top


There are 1.2 billion adolescents across the world; nine out of ten of these young people live in developing countries. India is home to more than 243 million adolescents, accounting for a quarter of the country's population.[1] Despite being a huge segment of the population, policies, and programs in India have focused very little effort on this group.[2] Adolescent reproductive health has been identified as a key strategy in the reproductive and child health-II program. The Constitution of India guarantees equal rights for men and women irrespective of caste, creed, and color. All citizens are entitled to equal protection under the law. There exist, however, very limited laws, regulations, or ordinances that are specifically designed to protect adolescents (particularly female adolescents) from exploitation and violence.

Teenage pregnancy (15–19 years) is emerging as a serious problem today worldwide and particularly in developing countries such as India as early marriages and early pregnancy are the accepted cultural norms of our society. The medical termination of pregnancy (MTP) act, 1972 has legalized abortion, yet the number of illegal providers of abortion services is very high. Lack of awareness about legal age of marriage is a common phenomenon in rural areas. Publicity of Child Marriage Restraint Act is poor and enforcement virtually nonexistent.[3]

There is little empirical data on prevalence of domestic violence and its determinants in India, particularly, it is important to understand this serious problem in a rural and low socioeconomic condition with poor educational and economic background of the females.[4]

Thus, making the adolescent's aware about legal and social issues/acts related to reproductive health is necessary to reduce maternal mortality ratio, infant mortality rate, and total fertility rate. Hence, the present study focuses on assessment of the awareness level of legal and social issues related to reproductive health and its association with the various individual and family/household level characteristics in rural areas of district Varanasi. The specific objective of the study is to find out the association of different socioeconomic and demographic variables of adolescent girls with their awareness about some important legal issues/acts related to reproductive health and further examine the effect of various characteristics on the likelihood of knowing these legal issues/acts.


   Materials And Methods Top


Ethics approval was taken from the Ethics Committee of the Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), Varanasi. The purpose of the study was explained to the respondents and consent was taken.

Study design

This is a community-based cross-sectional study that was conducted between January and June, 2011. 650 adolescent girls were selected in the age group of 15–19 years from rural Varanasi, under the research entitled “A study on reproductive and sexual health behavior among adolescent girls in rural areas of Varanasi.”

The research involves both quantitative and qualitative components to assess the awareness level of legal and social issues related to reproductive health and its association with the various individual and family/household level characteristics. Qualitative study (focus group discussions [FGDs]) was done to get the information about various legal and social issues/acts related to reproductive health among adolescent girls. Emerged themes from the qualitative study were addressed with pretested and predesigned semistructured interview schedule.

The following criteria were kept in mind while selecting the participants

Inclusion criteria

All 15–19 years girls irrespective of their educational and marital status were interviewed.

Exclusion criteria

If there were two girls of the same age group in a family, only one was selected by lottery method. Physically and mentally handicapped adolescent girls were also excluded from the study.

Sample size

To determine the sample size, a pilot study on 30 adolescent girls was conducted in nonstudy village, to know their awareness on different aspects of reproductive and sexual health. The awareness regarding reproductive tract infections/sexually transmitted infection (RTI/STI) (one of the objectives of the main study) was recorded lowest in the study area and it was about 5%. This proportion was considered as the key variable in sample size determination. The required number of sample households would be

nh= m × n = m × {p (1 − p) (z2/e2) × f}

Where,

n = required sample size for adolescent girls among 15–19 years of age.

m = required number of households to get at least one adolescent girl in age group of 15–19 years.

p = proportion of adolescent girls having the awareness of RTI/STI.

z = 1.96 (z value at 5% level of significance).

e = 0.025 (amount of admissible error).

f = 2.0 (assumed design effect).

Thus, as an approximation, suppose that about 5% of the adolescent girls in 15–19 years age group having the awareness about RTI/STI, then

n = p (1 − p) (z2/e2) × f = 292 × 2.0 = 584

The sample was further increased by 15% to account for contingencies such as nonresponse or recording error. Thus, the required minimum sample size came to be 584 × 1.15 = 671.6 = 672 (approx.). As per the National Family Health Survey-3[5] from 6 households in a village of Eastern Uttar Pradesh, one can get at least one adolescent girl in the age group of 15–19 years.

Thus, nh= 672 × 6 = 4032 households

Therefore, 4032 households were chosen from the rural areas to get the required number of adolescent girls in the sample. For getting the required adolescents, the complete enumeration of households had been done, after considering the average number of households in a village to be 500. Thus, eight villages were selected to get the required number of adolescents.

Sampling

For quantitative study, a multistage cluster sampling method was used. The following steps were taken to select the study subjects.

  • Stage 1: One community development block (i.e., Chiraigaon) was selected out of total eight blocks of district by simple random sampling method
  • Stage 2: Eight villages were selected randomly from the total eighty-four villages in a selected block. Each village was considered as one cluster
  • Stage 3: To get required number of respondents (672), the complete enumeration of each cluster was done. Due to inaccuracy and/or unreliability of information, 22 cases were excluded from the analysis. Finally, 650 respondents were considered for the analysis purpose. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) for Windows, Version 16.0, released in 2007 by SPSS Inc, Chicago.


Focusgroup discussions

FGDs were conducted according to the respondent's educational and marital status to get an idea about their awareness on legal and social issues/acts related to reproductive health. It was decided to conduct four group discussions. Out of which, two were conducted with school-going respondents irrespective of their marital status and other two with school dropouts. Each group has 8–10 participants. The groups were matched for the following characteristics; age, education and marital status, speaking the same language, and from similar socioeconomic background. A total of 40 respondents were recruited for group discussion by random selection from the list of 15–19 years old adolescent girls of selected villages. To maintain homogeneity, equal number was ensured from all categories, i.e., school-going and school-dropout, married and unmarried. Data from FGDs were transcribed verbatim from the audio record in Hindi and translated later into English. The data were then analyzed manually (without using any software) based on recurrent themes and patterns.

Dependent variable

In the present study, the knowledge about the acts related to five different aspects of reproductive health (legal age of marriage act, legal age of childbearing act, MTP act, dowry probation act, and domestic violence act) and knowing the total number of act/s are used as dependent variable. The knowledge about different acts is dichotomized (yes or no) and total number of acts known by the adolescents falls in a range from lowest possible (0; no act known) to highest possible (5; all the five acts known) value.

Independent variables

Two categories of the possible socioeconomic and demographic predictors of the dependent variables were established:

  1. The individual variables included age, marital status, birth order, and educational status of the adolescent
  2. The family or household variables included caste, religion, type of family, educational status of mother and father, and per capita income of the household. The per capita income of the household is classified into five classes (Class I, Class II, Class III, Class IV, and Class V) and computed using BG Prasad (2010) classification.



   Results Top


Out of the 650 respondents, more than half were of 15–17 years age group. In the present study, 23% were married and out of which, majority were below legal age of the marriage. Caste-wise distribution shows that half of the total respondents belonged to other backward caste and more than half were from nuclear families. Majority of the respondents was of first to third birth order. Almost all of the respondents were literate and only 5.2% were never been to school. Regarding their mother's education, nearly two-third of mothers were illiterate. Economic status shows that three-fourth of the respondents belonged to lower economic class, i.e., IV th and V th.

Respondents belonged to general caste were significantly more aware about the legal age of marriage and right age of childbearing as well as the dowry prohibition and domestic violence acts. Adolescent girls found living in joint families were significantly (P = 0.002) having high awareness about all the inquired issues/acts except the MTP. Effect of parent's educational status, specifically of mothers cannot be ignored in assessing the awareness level of their daughters regarding different legal issues/acts related to reproductive health. Furthermore, in the present study, respondents of the literate mothers were found significantly more aware about different legal acts as compared to the adolescents whose mothers were illiterate [Table 1].
Table 1: Respondents' awareness about legal and social acts by socioeconomic and demographic characteristics

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[Table 2] displays the results of logistic regression analysis considering all the independent variables together in predicting the likelihood of not having aware about different legal issues/acts inquired in the study. Respondents who were in higher age group, i.e., 18–19 years (odds ratio [OR] = 0.35, P < 0.001), educated up to high school and above (OR = 0.10, P < 0.01), literate mothers (OR = 0.38, P < 0.001), and belong to higher economic class (OR = 0.05, P < 0.05) were significantly less likely to become unaware about legal age of marriage and right age of childbearing. Married adolescent girls (OR = 2.07, P < 0.05) were significantly more likely to become unaware about the legal age of marriage. The respondents in higher ages, i.e., 18–19 years and belonging to higher economic class were also significantly less likely of becoming unaware about the MTP act. As far as concerned with dowry prohibition and domestic violence acts, respondents of higher age group, i.e., 18–19 years, more educated, of literate mothers were significantly less likely to become unaware about the concerned legal issues/acts. Surprisingly, the married respondents were significantly more likely (OR = 2.74, P < 0.001) to be unaware about the domestic violence act.
Table 2: Multiple logistic analysis-likelihood of unawareness about different legal acts versus different socioeconomic and demographic characteristics

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[Table 3] shows the results of multivariate regression analysis to assess the effect of various characteristics associated to individual as well as family/household level of the respondents on their awareness about the total number of legal issues acts inquired in the present study. Model I refers to the first stage in hierarchical method when only the individual characteristics of the respondent are used as predictors. Model II refers to when household level characteristics were used. Model I, when respondent's individual characteristics are taken only, causes R2 change from 0 to 0.449. The addition of the household level characteristics (Model II) causes R2 to increase by 0.11. The proposed hypothesis related to age, marital status, and educational level at individual level (concerned to adolescent girls) were rejected and these factors were found to have highly significant effect (P < 0.001) on the awareness about the total number of legal issues/acts known by the respondents as compared to the variables at family and household level of the respondents (mother's education, religion, and per capita income of the household.
Table 3: Regression analysis for awareness of the adolescents about the total number of legal acts versus various individual and household level variables

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Qualitative analysis shows that most of the school-going respondents irrespective of their marital status were aware about legal age of marriage and right age of childbearing, but very few of them were aware about dowry prohibition act and domestic violence act. None of them were aware about MTP act. Whereas among school-dropout respondents irrespective of their marital status, only few were aware about legal age of marriage and right age of childbearing. Similarly, none of them were aware about dowry prohibition act, domestic violence act, and MTP act. The present findings also show that awareness does not mean that the adolescent girls will marry at legal age of marriage, which is very well supported by the quote of one school-going unmarried respondent “Our awareness on legal age of marriage does not matter, only and only it depends on the decision of the parents.” This is also supported by one more respondent “why should I know the legal age of marriage if it is only decided by my parents. I have no choice whether I agree or not.”


   Discussion Top


Majority of adolescent girls still neither do have access to information on sexuality, reproduction, sexual and reproductive health, and rights nor do they have access to preventive and curative services. In the present study, 23% respondents were married, out of which 90% married below the age of 18 years and this may be due to the poor awareness of legal age of marriage and pressure from parents. Less than half (42.9%) of respondents were aware about legal age of marriage which is consistent with the findings of study conducted by Gupta et al.[6] and higher than the study conducted by Srivastava et al.[7] where only 31% of the respondents were aware. However, the corresponding figure from the studies of Prateek et al.,[8] Pattanaik et al.,[9] Mukhopadhyay and Paul,[10] and Dube and Sharma [11] was higher. Our finding is much lower than the study conducted by Naidu et al. where majority of the girls (90%) knew about legal age of marriage.

Early marriage is a risk factor for early pregnancy and poor reproductive health outcomes. In our study, only 14.9% of the respondents were aware about right age of childbearing and this is also supported by qualitative findings. However, findings of Kotwal et al.[12] reported a higher percentage of awareness about these acts, i.e., 60% which is very higher than our findings. Adolescent pregnancies are more likely to occur among poor, less educated, and rural populations.[13] Our finding shows very low (2.6%) awareness about MTP act, which is less than the study conducted in Belgaum, Karnataka, where 6.75% of respondents had knowledge about MTP act.[14] Regarding social issues less than 50% were aware about dowry prohibition act and 27% about domestic violence act. None of the girls was found aware about the majority of inquired issues/acts during group discussion. However, legal age of marriage and right age of childbearing were known to about one-fifth of respondents.

Age and educational status of the respondents were also found related with the awareness about domestic violence act which is similar to the findings of Sarkar; this is consistent with the findings of a study conducted in Turkey,[15] where low level of education was found to be a risk factor for domestic violence, and their knowledge regarding the sexual and reproductive health is limited. Negative perceptions and misinformation, which they gather from here and there often continues through their reproductive years and act as a barrier for healthy reproductive life. Due to social and cultural taboos and inhibitions, reproductive and sexual health research in rural areas particularly of Eastern Uttar Pradesh are less emphasized and remain restricted to a few number of studies for adolescent girls. This shows that there is a vast unmet need in the area of reproductive and sexual health of adolescent girls.


   Conclusion And Recommendations Top


Both qualitative and quantitative findings show the low awareness about all inquired legal issues and acts related to reproductive health. Awareness about legal age of marriage and dowry prohibition act was comparatively higher as compared to right age of childbearing, domestic violence, and MTP act. Further, we found the significant effect of education on awareness of these issues/acts. Therefore, this suggests that the strong need of inclusion of various issues/acts in the high school curriculum and female teachers should also be involved in training programs for adolescent girls. Concerted efforts for promotion of education of girls are required. Parents should also be counseled about the importance of awareness of various legal and social issues/acts. Health workers should be trained about all the legal and social issues/acts related to reproductive health.

Acknowledgment

We are grateful to BHU for providing research grant. We are thankful to social workers in the Department of Community Medicine, IMS, BHU, who helped in data collection.

Financial support and sponsorship

We are grateful to Banaras Hindu University for providing research grant (Ref. No. R/Dev/ix-Sch/7245; Development Account scheme no. 4027).

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
UNICE–India. The State of the World's Children: Adolescence - An Age of Opportunity. 2011.  Back to cited text no. 1
    
2.
NRHM, Ministry of Health and Family Welfare, India. Implementation Guide on RCH II, Adolescent Reproductive Sexual health Strategy. May 2006.  Back to cited text no. 2
    
3.
Parasuramalu BG, Shakila N, Rameshi NR. A study on teenage pregnant mothers attending primary health centres of Kempegowda Institute of Medical Sciences, Bangalore. IJPH 2010;54:205-8.  Back to cited text no. 3
    
4.
Sarkar M. A study on domestic violence against adult and adolescent females in a rural area of West Bengal. Indian J Community Med 2010;35:311-5.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Parasuraman S, Kishor S, Singh SK, Vaidehi YA. “Profile of Youth in India”, National Family Health Survey (NFHS-3), India, 2005-2006.  Back to cited text no. 5
    
6.
Gupta N, Mathur AK, Singh MP, Saxena NC. Reproductive health awareness of school-going, unmarried, rural adolescents. Indian J Pediatr 2004;71:797-801.  Back to cited text no. 6
    
7.
Srivastava S, Kariwal P, Kapilasrami MC. A community-based study on awareness and perception on gender discrimination and sex preference among married women (in reproductive age-group) in a rural population of district Bareilly Uttar-Pradesh. National Journal of Community Med 2011;2:273-6.  Back to cited text no. 7
    
8.
Prateek S, Bobhate MD, Saurabh R, Shrivastava MD. A cross sectional study of knowledge and practices about reproductive health among female adolescents in an urban slum of Mumbai. J Fam Reprod Health 2011;5:117-24.  Back to cited text no. 8
    
9.
Pattanaik D, Lobo J, Kapoor SK, Menon PS. Knowledge and attitudes of rural adolescent girls regarding reproductive health issues. Natl Med J India 2000;13:124-8.  Back to cited text no. 9
    
10.
Mukhopadhyay P, Paul B. An educational intervention study on improving awareness regarding some reproductive health issues among female school going adolescents. Indian J Prev Soc Med 2009;40:74-6.  Back to cited text no. 10
    
11.
Dube S, Sharma K. Knowledge, attitude and practice regarding reproductive health among urban and rural girls: A comparative study. Ethno Med 2012;6:85-94.  Back to cited text no. 11
    
12.
Kotwal N, Gupta N, Gupta R. Awareness of reproductive health among rural adolescent girls (A Comparative Study of School Going Girls and Dropout Girls of Jammu). Stud Home Community Sci 2008;2:149-54.  Back to cited text no. 12
    
13.
The Millennium Development Goals Report 2011. New York, United Nations; 2011. p. 21-35.  Back to cited text no. 13
    
14.
Purohit M. Comparison of Reproductive Health Awareness in Adolescent School Girls of Rural and Urban Areas of Belgaum Taluka – A Cross Sectional Study, a Dissertation Submitted to KLE University Belgaum, Karnataka; May, 2010.  Back to cited text no. 14
    
15.
Kocacik F, Dogan O. Domestic violence against women in Sivas, Turkey: Survey study. Croat Med J 2006;47:742-9.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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