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Access to health care, reproductive health and disability: A large scale survey in Sierra Leone

GROCE, Nora
TRANI, Jean-Francois
BROWN, Joyce Brown
KETT, Maria
BAH, Osman
MORLAI, Teddy
BAILEY, Nicki
2011

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This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services.

Trends in the timing of first marriage among men and women in the developing world

MENSCH, Barbara S
SINGH, Susheela
CASTERLINE, John B
August 2005

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The timing of first union merits investigation not only because of the close temporal link between marriage and the onset of childbearing, but also because the age when men and women marry has implications for the organization of family life and for gender relations within society. This paper begins by reviewing the contributions of various social science disciplines to an understanding of the timing of marriage. Using current status data from 73 countries provided by the United Nations Population Division and retrospective data from 52 Demographic and Health Surveys conducted between 1990 and 2001, we then examine recent trends in the timing of first marriage or union for men and women in the developing world. With the exception of South America for both sexes and South and Southeast Asia for men, substantial declines have occurred in the proportion of young men and women who are married. Given the differentials in the timing of marriage by educational attainment and residence, we assess whether the decline in the proportion of young people who are married is related to increases in schooling and urbanization. Expansion of schooling for women has had some impact, but a considerable portion of the reduction in early marriage is not explained by changes in levels of education. We consider other factors that might account for the increase in age at marriage. Finally, we review what is known about the consequences of changing age at marriage with a particular focus on risk of HIV infection.

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