“这取决于上帝”：尼日尔新婚少女推迟初育并追求其他未来的障碍。
"It is a thing that depends on God": barriers to delaying first birth and pursuing alternative futures among newly married adolescent girls in Niger.
机构信息
School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
, 151 Rue Faubourg St. Antoine, 75011, Paris, France.
出版信息
Reprod Health. 2019 Jul 18;16(1):109. doi: 10.1186/s12978-019-0757-y.
BACKGROUND
Pregnancy among adolescent girls in Niger contributes to 34% of all deaths among females ages 15-19, but there is a dearth of research as to the specific contextual causes. In Zinder region, an area that is especially impoverished and where girls are at heightened risk, there is very little information on the main obstacles to improving adolescents' health and well-being. This qualitative study examines the underlying social, individual and structural factors influencing married girls' early first birth and participation in alternative opportunities (such as education or economic pursuits) in Niger.
METHODOLOGY
In July of 2017, researchers conducted in-depth interviews with a non-probability sample of community members in three communes of Zinder Region, Niger. Participants (n = 107) included adolescent girls, husbands of adolescent girls, influential adults, community leaders, health providers, and positive deviants. All interviews were transcribed, coded and analyzed using Dedoose software.
RESULTS
Participants recognize the health benefits of delaying first birth, but stigma around infertility and contraceptive use, desire for children, and belief that childbirth is "God's will" interfere with a girl's ability to delay. Girls' social isolation, lack of mobility or autonomy, and inability to envision alternatives to early motherhood compound the issue. Participants favor adolescents' pursuit of increased economic opportunities or education, but would not support delaying birth to do so.
CONCLUSIONS
Findings indicate the need for a holistic approach to delaying early birth and stimulating girls' participation in economic and educational pursuits. Potential interventions include mitigating barriers to reproductive health care; training adolescent girls on viable economic activities; and providing educational opportunities for girls. Effective programs should also include or target immediate members of the girls' families (husbands, parents, in-laws), influential local leaders and members of the community at large.
背景
在尼日尔，少女怀孕导致了 15-19 岁女性死亡人数的 34%，但针对具体的背景原因的研究却很少。在津德尔地区，一个特别贫困、少女风险较高的地区，几乎没有关于改善青少年健康和福祉的主要障碍的信息。这项定性研究考察了影响已婚少女早育和参与替代机会（如教育或经济追求）的社会、个人和结构因素。
方法
2017 年 7 月，研究人员在尼日尔津德尔地区的三个公社进行了非概率抽样的社区成员深入访谈。参与者（n=107）包括少女、少女的丈夫、有影响力的成年人、社区领袖、卫生提供者和正面偏离者。所有访谈均使用 Dedoose 软件进行转录、编码和分析。
结果
参与者认识到推迟初育的健康益处，但对不孕和避孕的污名化、对孩子的渴望，以及认为分娩是“上帝的旨意”，都干扰了女孩推迟的能力。少女的社会孤立、缺乏行动或自主权，以及无法想象早期母性的替代方案，使问题更加复杂。参与者赞成青少年追求更多的经济机会或教育，但不会支持为了追求这些而推迟生育。
结论
研究结果表明，需要采取综合方法来推迟早育并促进少女参与经济和教育活动。潜在的干预措施包括减轻生殖保健方面的障碍；培训少女进行可行的经济活动；为少女提供教育机会。有效的方案还应包括或针对少女的直系家庭成员（丈夫、父母、姻亲）、有影响力的当地领导人和广大社区成员。
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