The Impact of Armed Conflict on Adolescent Transitions: A Systematic Review of Quantitative Research on Age of Sexual Debut, First Marriage & First Birth in Young Women Under the Age of 20 Years

BACKGROUND:

Young women in conflict-affected regions are at risk of a number of adverse outcomes as a result of violence, economic deterioration and the breakdown of community structures and services. This paper presents the findings of a systematic review of quantitative literature reporting how key sexual and reproductive health (SRH) outcomes among young women under the age of 20 years are affected by exposure to armed conflict; namely, sexual debut, first marriage and first birth. Increases in these outcomes among young women are all associated with potential negative public health consequences. It also examines and documents possible causal pathways for any changes seen.

METHODS:

To fit with our inclusion criteria, all reviewed studies included outcomes for comparable populations not exposed to conflict either temporally or spatially. A total of 19 studies with results from 21 countries or territories met our inclusion criteria; seven presented findings on marriage, four on fertility and eight on both of these outcomes. Only one study reporting on sexual debut met our criteria.

RESULTS:

Findings show clear evidence of both declines and increases in marriage and childbirth among young women in a range of conflict-affected settings. Several studies that showed increases in marriage below the age of 20 years reported that such increases were concentrated in the younger teenagers. Trends in fertility were predominantly driven by marriage patterns. Suggested causal pathways for the changes observed could be grouped into three categories: involuntary, gender and psycho-social and economic and material factors.

CONCLUSION:

The review reveals a paucity of literature on the impact of conflict on SRH outcomes of young women. Further quantitative and qualitative studies are needed to explore how conflict influences SRH events in young women over both the short- and longer-term.

Summary of suggested causal pathways relating to marriage

	Involuntary	Gender and psycho-social	Economic and material
Marriage increase	Increased opportunity for social contact between the sexes	Fear of sexual violence or loss of honour for unmarried women leads to marriage at younger ages	Disruption in girls schooling leading to earlier marriage/childbirth
	Increased competition for remaining males as marriage partners	Desire for increased social cohesion	Increased poverty leading to transactional marriages/early marriage to gain bride price
		Increased pro-natalism and conservatism supports early marriage and childbirth
Marriage decrease	Disruption and separation of the sexes		Cost of marriage, lack of employment opportunities and destruction of infrastructure
	Lack of available males due to conscription and differential mortality

Full article at:   http://goo.gl/Fv8Auy

By:  Neal S1, Stone N2, Ingham R3.

• 1Department of Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, S017 1BJ, UK. S.Neal@soton.ac.uk.
• 2Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, S017 1BJ, UK. ncs@soton.ac.uk.
• 3Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, S017 1BJ, UK. ri@soton.ac.uk.
• BMC Public Health. 2016 Mar 4;16(1):225. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health