Researchers interviewed 450 adolescent married women and 450 older married women from 80 squatter areas in Alexandria to compare knowledge, attitudes, and practices related to reproductive health care. In addition to the cross-sectional survey, four focus group discussions were held with older women (over age 20), with younger women (under age 20), and with husbands of the women in these two groups.

Egypt

In many parts of the developing world, girls marry shortly after puberty. Because of societal pressures to prove their fertility and the increased status that motherhood brings, many young women become pregnant soon after marriage. The 1995 Egyptian Demographic and Health Survey found that 10 percent of the female population under age 20 had begun childbearing. Yet, few adolescents know about or understand the concept of reproductive health, according to a research project in Alexandria.

Research Findings

Researchers interviewed 450 adolescent married women and 450 older married women from 80 squatter areas in Alexandria to compare knowledge, attitudes, and practices related to reproductive health care. In addition to the cross-sectional survey, four focus group discussions were held with older women (over age 20), with younger women (under age 20), and with husbands of the women in these two groups.

• Women said the mean ideal age for marriage was about 20 years. Reasons for this age were "to be sensible and mature enough" and "to withstand the burden of pregnancy." However, women often married and began childbearing before age 20. The mean age at first pregnancy was 17.6 years for adolescent wives, 19.3 years for older women.

• The data suggested that Egypt's high rate of consanguineous (blood relationship) marriages was one factor related to marriage before age 20. Reasons for consanguineous marriage included: "increase family links," "they knew each other and everything would be clear before marriage," "customs and traditions," and "less cost." About one-fifth of the women in both groups were married to a first cousin.

• Nearly all the women in this sample had been circumcised. Eleven percent of the women in both groups experienced difficulties, such as excessive bleeding, severe pain, and fear. Seventy-seven percent of adolescents and 81 percent of older women agreed that "it is important for a girl to be circumcised." Reasons included "as our parents did before," "tradition," "to protect the girl," "religion" and "cleanliness." Sixty-six percent of adolescents and 72 percent of older women said they would have their daughters circumcised.

• Men preferred that their wives have a child as soon after marriage as possible, believing that children are an investment and represent security in old age. According to an illiterate husband of an adolescent wife, "Educated people consider first to establish themselves, but for us, we like to have children soon after marriage." Husbands preferred more children than did their wives.

• All women knew about family planning methods, though older women knew about more methods than did adolescent women. Ninety-five percent of the women in both groups approved the use of family planning, recommending it because, "life is expensive," and "women who have many children suffer from bad health." Eighteen to 19 percent of the husbands knew about a family planning method that could be used by men and identified this method as the condom. Fewer than 3 percent had actually used this method.

• Women generally thought family planning use was a joint decision or within the wife's purview. One educated, older wife stated, "The husband and wife together should agree, decide, and go together."

• Thirty-nine percent of adolescent wives and 63 percent of the older wives were using contraception at the time of the survey. Adolescent wives were more likely than older women to be using the intrauterine device. Older women were more likely to be using pills. Researchers found determinants of nonuse of contraception included being an adolescent wife, being illiterate, having an illiterate mother, having neither radio nor television in the home, and a previous pregnancy resulting in a stillbirth or miscarriage.

• Governmental organizations were the main providers of family planning services to women in this study. Most women said they were satisfied with family planning services, primarily because of the "good care" they received. When asked how services could be improved, women suggested "more working staff," and "more working hours." Husbands said they preferred that their wives see female physicians.

Recommendations

Adolescents should receive information about reproductive health, including family planning. They should be educated about the health benefits to mother and child when pregnancy is delayed until age 20 or older, and they should receive information about contraceptive methods available to them, and how and where to obtain them. Because cultural taboos may discourage frank discussions about sexual issues, young men and women should receive education and information to improve their communication skills on family planning and reproductive health issues. Policy-makers and health providers should target men since they are primary decision-makers in the home. Community leaders should be involved in setting up education and information programs for young adults.

Study Details

Dr. Sunny Abdou Sallam was the principal investigator, and Dr. Ahmed A.R. Mahfouz and Dr. Nihad I. Dabbous were co-prinicipal investigators responsible for this study, all from the High Institute of Public Health in Alexandria University. The field costs and technical assistance for this study were supported through the Research Management Unit of the National Population Council by a contract from the U.S. Agency for International Development/Cairo's FP/POPIII Project. Additional support for technical assistance came from the Women's Studies Project of Family Health International (FHI), through a Cooperative Agreement funded by the U.S. Agency for International Development. Dr. Cynthia Waszak of FHI served as technical monitor.