Child marriage—cohabitation or marriage before age 18—undermines a girl’s ability to obtain an education and develop autonomy, and exposes her to the dangerous consequences of childbirth before physical maturity. Laws against child marriage have been passed in numerous Sub-Saharan African countries, but often go unenforced or are undercut by age-of-consent laws that allow exceptions under certain conditions. To determine if consistency in the legal age of 18 for women to marry, to marry with parental consent and to consent to sex is associated with lower prevalence of child marriage and of adolescent birth, Belinda Maswikwa and colleagues conducted a study in 12 Sub-Saharan African countries with recent Demographic and Health Survey data [see article]. After adjustment for other variables, their analysis found that the four countries with consistent laws had a 40% lower prevalence of child marriage and a 25% lower prevalence of adolescent childbearing than did those with inconsistent laws. The authors suggest that educating communities about these laws is an important step toward enforcing them, especially since "early marriage has been practiced for generations and is seen as a culturally legitimate way of protecting girls from premarital sex and any potentially dishonorable consequences."

In much of Sub-Saharan Africa, contraceptive prevalence remains low and unmet need for contraception remains high. To examine whether and how the quality of family planning services affects use of modern methods in urban Kenya, Katherine Tumlinson and colleagues used demographic and contraceptive use data from a representative sample of women in each of five cities, along with service data from provider interviews and facility audits from public and private facilities offering family planning services in those cities [see article]. For a subsample of 126 higher volume facilities, additional data on service quality were collected through exit interviews with clients. In a multivariate analysis using the full sample of facilities, receiving an explanation of the potential side effects of their chosen method was the only variable associated with women’s use of modern contraceptives. However, in an analysis restricted to clients of higher volume facilities who had provided an exit interview, those whose provider had asked about their preferred method, had helped them select a method or had treated them "very well" were more likely to be using a modern method. The researchers suggest that efforts to help with method selection and treat clients well have the potential to increase modern contraceptive use in urban Kenya.

Malnutrition is the leading cause of child morbidity and mortality in Bangladesh, where 40% of children younger than five are stunted, 14% are wasted and 35% are underweight. Using Demographic and Health Survey data, which indicate that 14% of recent births in the country were unwanted at conception and 16% were mistimed, Md. Mosfequr Rahman sought to determine if child malnutrition is linked to unintended pregnancy [see article]. Compared with children whose conception had been intended, those whose conception had been unwanted were more likely to be stunted (46% vs. 39%), wasted (19% vs. 15%) or underweight (43% vs. 33%). In multivariate analyses, children unwanted at the time of conception had elevated odds of being stunted (1.4), wasted (1.4) or underweight (1.3); for children whose conception was mistimed, the odds of these outcomes were similar to those for children whose conception had been intended. According to the author, these findings may indicate conscious or unconscious neglect of an unwanted child. If the study’s results are supported by future longitudinal studies, Rahman adds, preventing unwanted pregnancies could help to reduce the prevalence of childhood malnutrition and associated morbidity and mortality.

According to a study by Bo Wang and colleagues, male and female adolescents in the Bahamas were more likely to engage in sexual risk behavior if they perceived greater involvement by their peers in sex and use of alcohol and drugs [see article]. However, the more their parents monitored their activities, the less likely they were to engage in sexual risk behavior. The study, based on four waves of longitudinal data, also showed that for males only, greater sexual risk behavior predicted lower levels of parental monitoring; for females only, greater risk behavior predicted higher levels of perceived peer risk involvement. These findings, the researchers say, highlight the important influence of perceived peer risk involvement on adolescents’ sexual behavior, and gender differences in how adolescents’ sexual risk behavior influenced parental monitoring and perceived peer risk involvement.

Despite increases in the use of modern family planning methods, Malawian women have a high unmet need for contraception. To explore the role of social norms, partner dynamics and attitudes toward contraception in decisions on method use, Neetu A. John and colleagues conducted focus group discussions with married men and married women in Malawi [see article]. Data from these discussions indicate that whether women adopt a method, which one they choose and whether they continue to use it are affected by a method’s perceived impact on sexual pleasure, especially male pleasure. This influence is strengthened by societal norms that assign women the role of providing pleasure in sexual relationships. Because their spouse may abandon them or take another wife if his sexual needs are not met, women must weigh the benefits of method use against how it might affect his sexual pleasure and, thus, the dynamics of their relationship. In this context, the authors say, women’s decision making on contraceptive use is a complex calculation that goes beyond such issues as method access, method effectiveness and desire to prevent pregnancy.

—The Editors