DISSERTATION ON
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HEALTH CONSEQUENCES OF EARLY AND LATE MARRIAGE
AMONG ADOLESCENT GIRLS AT SELECTED GOVERNMENT SCHOOLS, CHENNAI
M.SC (NURSING) DEGREE EXAMINATION BRANCH – IV COMMUNITY HEALTH NURSING
COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003
A dissertation submitted to
THE TAMIL NADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI- 600 032
In partial fulfillment of the requirement for the award of degree of
MASTER OF SCIENCE IN NURSING
OCTOBER – 2019
DISSERTATION ON
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HEALTH CONSEQUENCES OF EARLY AND LATE MARRIAGE
AMONG ADOLESCENT GIRLS AT SELECTED GOVERNMENT SCHOOLS, CHENNAI
Examination : M.Sc(Nursing) Degree Examination Examination month and year : OCTOBER - 2019
Branch & Course : IV – COMMUNITY HEALTH NURSING
Register No : 301726155
Institution : COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003
Sd: __________________ Sd: __________________
Internal Examiner External Examiner
Date: __________________ Date: __________________
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY,
CHENNAI – 600 032.
CERTIFICATE
This is to certify that this dissertation titled, “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HEALTH CONSEQUENCES OF EARLY AND LATE MARRIAGE AMONG ADOLESCENT GIRLS AT SELECTED GOVERNMENT SCHOOLS, CHENNAI”, is a bonafide work done by G.TAMILARASI, M.Sc(Nursing) II year Student, College of Nursing, Madras Medical College, Chennai -03, submitted to the Tamil Nadu Dr.M.G.R. Medical University, Chennai in partial fulfilment of the requirement for the award of the degree of Master of Science in Nursing Branch – IV, Community Health Nursing under our guidance and supervision during academic year 2017 – 2019.
Ms. A.Thahira Begum, M.Sc (N)., MBA., M.Phil., Principal,
College of Nursing, Madras Medical College, Chennai -03.
Dr.R.Jayanthi, MD, FRCP(Glasg) Dean,
Madras Medical College, Chennai -03.
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HEALTH CONSEQUENCES OF EARLY AND LATE MARRIAGE
AMONG ADOLESCENT GIRLS AT SELECTED GOVERNMENT SCHOOLS, CHENNAI
Approved by the Dissertation Committee on 24.07.2018
CLINICAL SPECIALITY GUIDE
Selvi.B.Lingeswari, M.Sc(N)., MBA., M.Phil., _____________
Reader in Community Health Nursing, College of Nursing,
Madras Medical College, Chennai -03.
HEAD OF THE DEPARTMENT
Mrs.A.Thahira Begum, M.Sc(N)., MBA., M.Phil., _____________
Principal,
College of Nursing,
Madras Medical College, Chennai-03.
DEAN
Dr.R.Jayanthi, MD., F.R.C.P. (Glasg)., ___________
Dean,
Madras Medical College, Chennai-03.
A Dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI
In partial fulfillment of the requirement for award of the degree
MASTER OF SCIENCE IN NURSING
OCTOBER – 2019
ACKNOWLEDGEMENT
“Success is an acknowledgement honored by a group who values your actions in the specificity of the venture they cherish .”
– Rejean Nantel I thank the Lord almighty for showering his blessings to make my dream of studying in an esteemed college possible in real. He has been bestowed his blessings over me throughout the course of my study period and in completion of this dissertation successfully.
My sincere thanks to Dr.R.Jayanthi, MD., F.R.C.P.(Glasg)., Dean, Madras Medical College, Chennai – 03 for permitting me to conduct the study in this prestigious institution.
I am more privileged to thank Institutional Ethics Committee, of Madras Medical College, Chennai - 03 for giving me an approval to conduct this study.
I express my heartfelt thanks to Ms.A.Thahira Begum, M.Sc(N)., M.B.A., M.Phil., Principal, College of Nursing, Madras Medical College, Chennai -03 for her constant visionary support and untired efforts which motivated us in completion of the study successfully. Her kind guidance is truely immeasurable.
I extend my thanks to Dr.R.Shankar Shanmugam, M.Sc(N)., M.B.A., Ph.D., for all his motivating efforts in driving us to complete the study in a right way. His motivating words and supportive inputs helped us to take the study in an appropriate direction and complete at the right destiny.
My great pleasure and privileges to express my gratitude to Selvi.B.Lingeswari, M.Sc(N)., Reader, Community Health Nursing Department, College of Nursing, Madras Medical College, Chennai – 03
for her constant support, calm approach, supportive guidance which helped me to complete the study peacefully and successfully.
I express my special thanks to Dr.Joy Patricia Pushparani, M.D., Professor, Institute of Community Medicine, Madras Medical College, Chennai - 03 for her valuable guidance and encouragement which enabled me to accomplish this study.
My sincere thanks to Ms.N.Sathyanarayani, M.Sc(N)., Reader, former lecturer in Community Health Nursing Department, Mrs.T.Ramanibai, M.Sc(N)., Reader, Community Health Nursing Department and Mrs.R.Sumathi, M.Sc(N)., Reader, Nursing Administration Department in College of Nursing, Madras Medical College, Chennai -03 for their sincere, support and motivating efforts and facilitation which guided us in making the study successfully.
I express my sincere gratitude to Ms.G.Mala, M.Sc(N)., Ph.D., former Nursing Tutor, Mr.K. Kannan, M.Sc(N)., Nursing Tutor, and Mrs.P.Tamil Selvi, M.Sc(N)., Nursing Tutor, College of Nursing, Madras Medical College, Chennai -03 for their valuable suggestions and in carrying out the study.
It is my privilege to express my gratitude to Mrs.L.Shanthi, M.Sc(N)., former head of the community health nursing department, College of Nursing, Madras Medical College, Chennai -03 for their timely support in selection of the topic for the dissertation and preparing us for the proposals.
I wish to express my gratitude to all the Faculty Members of College of Nursing, Madras Medical College, Chennai - 03 for their valuable guidance and suggestions in conducting this study.
Vanagaram, Chennai – 95 for provoking the tool constructed for the study and for the valuable suggestions in bringing the tool in a right way.I also express my special gratitude to Mrs.Kanchana, M.Sc (N)., Madha College of Nursing, Kundrathur, Chennai – 95 for her valuable suggestions in bringing the tool in a right way for the study.
Its my pleasure to express my heartfelt gratitude to Mr.Kumaravel Pandian, I.A.S Deputy Commissioner [Education], Greater Chennai Corporation, Ripon Building, Chennai. for permitting me to conduct the study in Schools under the ambit of Chennai Corporation.
My sincere thanks to Retd. Dr.A.Vengatesan, M.Sc., M.Phil., Ph.D., Deputy Director (Statistics), Directorate of Medical Education, Chennai for his valuable suggestion and guidance in the successful completion of statistical analysis and compiling of this study.
My special word of thanks to Mr.Ravi, M.A., MLIS., Librarian for extending his support in providing all the necessary materials needed to complete the study in an organized manner.
My deepest gratitude to P.Petchiammal M.A, B.Ed., B.T Assistant Government Higher Secondary School, Adamangalam for editing the tool and content in English and Mrs.Mahadevi M.A., M.Ed Assistant Government Higher Secondary School, Adamangalam for editing the tool and content in Tamil for thesis work.
I express my heartfelt gratitude to The Headmistress Mrs.Nalini M.A, B.Ed Chennai Girls Higher Secondary School, Choolai, Chennai who had extended co- operation during the study.
I owe my great sense of gratitude to Mr.Jas Ahamed Aslam, Shajee Computers and Mr.M.Ramesh B.A., MSM Xerox for their
enthusiastic help and sincere effort in typing manuscript using valuable computer skills and also bringing this study into a printed form.
I will be lost if I am not expressing my gratitude to my family members. I express my heartfelt thanks to my ever loving parents Mr.K.A.Ganapathy [Late], Mrs.G.Vithya and my brother Major G.Madhialagan the back bone of my life who sacrificed their present for my future. They are the one who brought up me with the good attitude through their constant motivation and encouragement that has led me to work out on this study successfully. Without them I might not be successful today.
I extend my immense love and gratitude to my husband Mr.M.C.Jayakumar, who has shared my life along with all my responsibilities. His patience and care helped me to complete the study stress free. I extend my immense love and offer praise from my heart to my lovable kids Mast.J.Dhipag and Mast.J.Gowtham Vijay for their love, support and adjustments which helped me to complete the study successfully.
I am grateful to my colleagues Mrs.D.Madhurima, Ms.M.Vigneshwari, Ms.S.Pabitha and Ms.N.Athiba for extending their participation and support with their timely suggestions during the time of data collection. I also extend my sincere gratitude to all my friends.
My heartfelt thanks to all the school children who have participated in this study. without their participation I couldn’t complete the study.
ABSTRACT
Adolescence is a transitional stage of physical, psychological and social development that generally occurs during the period from puberty to adulthood. The word ‘adolescence’ is a Latin word derived from
‘adolescere’ which means’ to grow into adulthood’. World Health Organization define, adolescence is period of life between 10 to 19 years .It is an important and sensitive period in the life of an individual.
Adolescent is the time between being a child and a mature adult.
Adolescents are frequently called "teenagers" or" teens".
Early marriage is defined as “marriage or union between two parties in which one or both parties are younger than 18 year old. Late marriage naturally result in late pregnancy, it is defined as pregnancy above 35 year of age. It results in complications which affect health of mother as well as babies. Such as difficult for conceiving after age of 35, pre eclampsia, risk for miscarriages, the chances of fetus having genetic defect and still births .
TITLE
A study to assess the effectiveness of structured teaching programme on knowledge regarding health consequences of early and late marriage among adolescent girls at selected Government Schools, Chennai.
OBJECTIVES
The study was carried out i] to assess the pre test level of knowledge regarding health consequences of early and late marriage among adolescent girls, ii] to evaluate the effectiveness of structured teaching programme (post test) on health consequences of early and
late marriage among adolescent girls , iii]to compare the pre-test and post- test knowledge regarding health consequences of early and late marriage among adolescent girls and iv] to find association between the post test knowledge of adolescent girls and selected demographic variables.
METHODOLOGY
The study was conducted with 60 samples (Adolescent girls) in quantitative approach. Pre experimental one group pre test post test design, sample selection was done by purposive sampling technique method. Pre- existing knowledge was assessed by using semi structured questionnaires. After the pre-test, structured teaching programme was given regarding health consequences of early and late marriage among adolescent girls. After 7 days post test was conducted by using same tool.
RESULTS
The findings of the study revealed that structured teaching programme had improved the knowledge regarding health consequences of early and late marriage among adolescent girls with paired t test, p<0.001. There is statistically significance in knowledge attainment on regarding health consequences of early and late marriage shows effectiveness of structured teaching programme.
CONCLUSION
The result of study shows that structured teaching programme was effective in improving knowledge regarding health consequences of early and late marriage among adolescent girls.
TABLE OF CONTENTS
CHAPTER CONTENT PAGE
NO
I INTRODUCTION 1
1.1 Need for the study 5
1.2 Statement of the problem 9
1.3 Objectives 9
1.4 Operational definitions 9
1.5 Hypothesis 10
1.6 Assumptions 10
1.7 Delimitation 10
1.8 Conceptual framework 10
II REVIEW OF LITERATURE 15
2.1 Literature review related to the study 15
III METHODOLOGY 36
3.1 Research approach 36
3.2 Research design 36
3.3 Setting of the study 37
3.4 Duration of the study 37
3.5 Study population 37
3.6 Sample 37
3.7 Sample size 38
3.8 Sampling technique 38
3.9 Research variables 38
3.10 Development and description of the tool 38
3.11 Score interpretation 40
3.12 Content validity 40
3.13 Ethical consideration 41
3.14 Reliability 42
3.15 Pilot study 42
CHAPTER CONTENT PAGE NO
3.16 Data collection procedure 43
3.17 Data analysis 44
IV DATA ANALYSIS AND INTERPRETATION 48 4.1 Description of the demographic variables 48 4.2 Description of the pre test knowledge of the
sample 55
4.3 Description of post test knowledge of the
sample 56
4.4 Comparison of pre-test and post-test level
of knowledge 58
4.5 Effectiveness of the structured teaching
programme 59
4.6 Association of post test level of knowledge with selected demographic variables of
adolescent girls. 61
V DISCUSSION 65
VI SUMMARY AND CONCLUSION 73
6.1 Summary 73
6.2 Implications 76
6.3 Recommendations 77
6.4 Limitations 78
6.5 Conclusion 78
REFERENCES ANNEXURES
LIST OF TABLES
TABLE.
NO TITLE
3.1 Intervention protocol for Pre-experimental group
4.1 Description of demographic variables of the study participants
4.2 Description of pre test knowledge level of knowledge among adolescent girls
4.3 Description of post test knowledge level of knowledge among adolescent girls
4.4 Comparison of pre test and post test level of knowledge 4.5 Effectiveness of structured teaching programme and
generalization of knowledge gain score
4.6 Association of post test level of knowledge with selected demographic variables of adolescent girls .
LIST OF FIGURES
FIG.
NO TITLE
1.1 Empowerment, Research and Care Model in Community Health Nursing
1.2 Conceptual framework based on modified Penders health promotion model
3.1 Schematic Representation of the methodology 4.1 Age Distribution
4.2 Type of family
4.3 Number of siblings in the family 4.4 Education status of father
4.5 Occupation status of father 4.6 Education status of mother 4.7 Occupation status of mother 4.8 Monthly income of family 4.9 Religion of the family 4.10 Living place of the family
4.11 Pre test Knowledge Score of the participants 4.12 Post test Knowledge Score of the participants
4.13 Comparison of pre test and post test level of knowledge score 4.14 Effectiveness of structured teaching programme
4.15 Association between post test level of knowledge score and adolescent girls age
4.16 Association between post test level of knowledge score and type of family
4.17 Association between post test level of knowledge score and number of siblings in the family
4.18 Association between post test level of knowledge score and place of living
ANNEXURES
S.NO CONTENT
1. Certificate of approval from Institutional Ethics Committee 2. Permission letter from Chief Educational Officer
3. Certificate of content validity
4. Informed consent - English and Tamil 5. Certificate of English Editing
6. Certificate of Tamil Editing
7. Tool for Data Collection - English and Tamil 8. Lesson plan - English and Tamil
9. Photograph
10. Booklet regarding health consequences of early and late marriage
LIST OF ABBREVIATION
S.NO ABBREVIATION EXPANSION
1 CI Confidence Interval
2 DF Degree of freedom
3 Fig Figure
4 H1 and H2 Research hypothesis
5 SD Standard Deviation
6 P Significance
7 X2 Chi square test
8 STP Structured Teaching Programme
9 CEO Chief Educational Officer
10 TOI Times of India
11 NFHS National Family Health Services 12 UNICEF United Nations International Child
Emergency Fund
13 WHO World Health Organization
CHAPTER – I INTRODUCTION
"Marriage - a book of which the first chapter is written in poetry and the remaining chapter is prose".
-Beverley nicholas Adolescence is a transitional stage of physical, psychological and social development that generally occurs during the period from puberty to adulthood. The word ‗adolescence‘ is a Latin word derived from
‗adolescere‘ which means‘ to grow into adulthood‘. World Health Organization define, adolescence is a period of life between 10 to 19 years .It is an important and sensitive period in the life of an every individual.
Adolescent is the time between being a child and a mature adult.
Adolescents are frequently called "teenagers" or" teens".
A– Aggressive, anemic, abortion
D– Dynamic, developing, depressed
O - Overconfident, overindulging, obese
L– Loud but lonely and lack of information
E– Enthusiastic, explorative and experimenting
S– Social, sexual and spiritual
C– Courageous, cheerful and concern
E– Emotional, eager and emulating
N– Nervous, never say no to peers
T– Temperamental, teenage pregnancy
Marriage by scriptural definition ―is the blending together of two lives, two personalities of the opposite sex for as long as two shall live in this world. It is the building of a home that respects the law of god and protects the morals of mankind. Marriage may occur as too early or too late .There are numerous problems, a couple can face when marriage happen at an early age.
Early marriage is defined as "marriage or union between two parties in which one or both parties are younger than 18 year old", before the girl is physically, physiologically, psychologically ready to adopt the responsibility of marriage and child bearing. So early marriage means individual are attaining reproductive stage early and give rise to children early. The causes may occurs due to religious hurdles and barriers, lack of knowledge and education, Family norms and traditions customs and beliefs, lower socio economic status, myths and misconceptions. The effect of early marriage may leads to physiological and psychological stress, denial of freedom and personal development and denial of education.
Teenage pregnancy is one of the burning issues and emerging serious problem in health, today all over the world, in the developing countries like India. In recent years the incidence is increasing due to early onset of puberty. Although adolescent marriage is a cognizable offence in India, it is still a common practice in many parts of the country. A high fertility rate, social customs, poverty and i gnorance make early marriage a common feature in this part of the world.
Girls who marry earlier in life are less likely to be informed about reproductive issues and because of this, pregnancy related deaths are known to be leading cause of mortality among married girls between 15 – 19 years of age. The girls are twice more likely to die in childhood
than girls between 20 and 24 years of age . Girls younger than 15 years of age are five times more likely to die during childbirth.
Child marriage is a human rights violation. Despite laws against it, the practice remains widespread: Globally, one in every five girls is married, or in union, before reaching age 18. In the least developed countries, that number doubles – 40 per cent of girls are married before age 18, and 12 per cent of girls are married before age 15
Late marriage naturally result in late pregnancy, it is defined as pregnancy above 35 year of age. It results in complications which affect health of mother as well as babies. Such as difficult for conceiving after age of 35, pre eclampsia, risk for miscarriages, the chances of fetus having genetic defect and still births . So women should be aware of ideal time of marriage and pregnancy.
According to recent report India TV lifestyle Desk Dr. Sameer Kaul[2016] said that late marriages and late pregnancy have contributed to incidence of cancer among women.The report states that 46% of women suffering from cancer are under 50, 2% of Indian women suffering from cancer are in 20 to 3 years of age group,16% are in 30 to 40, 28% in 40 to 50 age group. Almost 46% of women are below 50 years.
BACKGROUND OF THE STUDY
Marriage is also called matrimony or wedlock, it is one of the culturally recognized and union between people and establishes rights and obligations between them. Marriage in the United States is a legal, social, and religious institution. Whereas in India, it is a custom.
World Health Organization reports that pregnancy and childbirth complications are the more leading cause of death among 15 to 19 years girls. More than 650 million women, and over 150 million
men, already suffer the consequences of child marriage. If current trends on child marriage continues,150 million more girls will be married in childhood by 2030, with devastating consequences for the whole world.
The sustainable development goals aims to end child marriage by 2030.Early marriage should be avoided to attain this goals.
The World Vision Report says that in 2013, 650 million women alive today married before they turned 18. Child marriage sets them up for a life of hardship, they are less likely than their peers to stay in school and more likely to become victims of domestic violence.
United Nation International Child Emergency Fund, reports about 60% to 70% of girls are forced to early marriages especially in South African and Asian countries which results in several psychological and physiological problems occur which leads to divorce and suicide. UNICEF also reported, that a girl who married early five times more likely to die during pregnancy, and child birth.
The Red Elephant Foundation [2016] says that 36% of women aged 20- 24 years were married before they reached 18 years, and 14 million adolescents between 15 and 19 years give birth each year.
The recent reports on late marriage claimed that late pregnancy have contributed to incidence of cancer among women. As per Times of India statistics in November 2017 nearly 1,600 child marriages reported in TamilNadu. Krishnagiri, Dharmapuri reported the highest number of child marriages with 180, followed by Salem and Tiruvannamalai at 135.About 3% of early marriage cases were reported in Chennai, Kancheepuram and Tiruvallur.
Several research study revealed that adolescent girls lack of knowledge on early and late marriage. The number of early and late
there is a need for the promotion of educational programmes regarding the consequences of early and late marriage among the adolescent groups. Adolescent girls spend more time in schools. So, i have selected them to educate the consequences of early and late marriage in order to empower them to face challenges in life.
1.1 NEED FOR THE STUDY
A good marriage would be between a blind wife and a deaf husband - Michel De Montaigne JAVIER AGUILAR, A CHIEF OF CHILD PROTECTION IN UNICEF said that, India constitute more than 20% of the world's adolescent population and added that India accounts for the highest number of child marriages in South Asia. He also stated that in the current India scenario about 27% of girls, or nearly 1.5 million girls, get married before they turn 18.
According to the UNICEF global databases, between 2010 and 2016, the percentage of women between 20 and 24 years old married before 15 years of age is 6%, and it increases to 25% when referring to women married before 18 years old. The country with the highest number of child marriage is Nigeria, followed by Nepal which however has the highest prevalence of child marriage with female under 15 years of age.
The global report on burden of child marriage has showed that, the problem of child marriage is prevalent in South Asia and Sub- Saharan Africa, where 38 percent of young women are married before the age of 18. Ethiopia is one among the top five countries for child marriage in Sub-Saharan Africa.
UNCIEF reports that, India has the highest absolute number of child brides in the world statistically over 15,509,000 and 27% of girls in India are married before their 18th birthday and 7% are married before the age of 15.
A study published by UNICEF Titled“State of the World’s Children” reported that in 2017 more than 15 million women in India who married when they were children.
According to the Union health ministry's Family Welfare Statistics 2011, compiled by the Registrar General of India, for every woman aged below 18 years getting married in urban centres, three women are doing so in rural areas. In percentage-wise decline, Jammu and Kashmir has seen the largest dip in under-aged brides in the recorded five years at 83%, followed by Chhattisgarh (78%), Andhra Pradesh (71%), Haryana (70%) and Madhya Pradesh (69%).Maharashtra has seen 57% decline in under-aged brides, Delhi (53%), Bihar (55%), Odessa (48%), Karnataka (44%) and Punjab (46%). States with lowest percentage of decline in under-aged brides since 2005 include West Bengal (14%), Rajasthan (23%), Jharkhand (27%), Tamil Nadu (29%), Gujarat (33%) and Uttar Pradesh (38%) 9. Child marriage is prohibited by law in India, with the minimum age of marriage being 18 for girls and 21 for boys. However, the recent survey says 48% of women were married or in union before 18 years, and almost one in five were married or in union before 15 years.
According to NFHS-III survey among the women aged between 20 to 24, 47.3% were married by age 18. The survey reported that among the child marriage, 2.6 percent were married before they turned 13, 22.6% were married before they were 16, and 44.5 percent were married when they were between 16 and 17. The study concluded that
followed by Uttar Pradesh[64%] and the same report revealed that Tamil Nadu ranked in the 7th place reporting about 53% of nation's child marriage.
National Family Health survey - 4 , conducted in 2015 - 2016, their data reported that the prevalence of child marriage among 15-19 and 20-24-years old was 11.9% and 26.8% respectively for girls in India. Child marriage prevalence in rural and urban India is 14.1% and 6.9% respectively for the age group 15-19 and 31.5% and 17.5%
respectively for rural and urban areas for the age group 20-24-years.
Prevalence of below legal age marriage for single year age from 15 to 19 years highlight that prevalence of below legal age marriage increases as girls transition through adolescence with lowest prevalence reported at age 15 (2.7%) and highest at age 19 (20.5%)
Girls Not Brides — a global partnership of more than 1,000 civil society organizations committed to ending child marriage. Their study results rvealed that 27 percent of Indian girls are married before the age of 18, and 7 percent by the age of 15.
India is one of the 12 countries selected to be part of the UN Population Fund and UNICEF‘s Global Program to Accelerate Action to End Child Marriage.
The Hindu daily reported that, in the year of 2017 in Tamil Nadu the average age of child marriage was 16.4 years and about 75%
of those marriages were arranged by their parents. About 95% of marriages were due to love affairs.
Sameer Kaul, Senior Consultant of Surgical Oncology at Indraprastha, Apollo Hospital to a leading daily.
Dr.Sameer Kaul,Senior Consultant of Surgical Oncology at Indraprastha, Apollo Hospital reported to a leading daily of recent
reports, doctors claim that late marriages, multiple sex partners and la te pregnancy have contributed the incidence of cancer among women. This report stated that 46% of women suffering from cancer are under 50, which is a worrying trend that's likely to continue in the coming years due to lifestyle changes. 2% of the Indian women suffering from cancer are in 20 to 30 years age group, 16%are in 30 to 40, 28% are in 40 to 50 age group. So, almost 46% women patients are below 50 years.
Fig.1.1 Empowerment, Research and Care Model in Community Health Nursing
EMPOWERING PATIENT RESEARCH CARE MODEL
Bateman Horne centre derives the model of empowering which frames that
Empowering : Empowering the clients[adolescents] with information and education with modules regarding the consequences of early and late marriage will help the clients to promote their health by adopting the
Improving Patient Care Empowering
Patients With Information And
Education
Advanced Research
Advancing Research
: Various research reviews on early and late marriages suggests that there is a need for educating the
adolescent girls on the consequences of early and late marriage.
Improving Clinical care
: Appropriate actions to be enforced on the adolescent to educate the girls on the consequences of early and late marriage. This also can be done through the School health services with a help of teaching aids and instructional modules.
The above mentioned model specifies the importance of nurses role in empowering the adolescent girls for adapting life style practices.
Community health nurse should acively take part in school health services and to use the advanced research in imparting knowledge to the school children in having healthy practices.
Above all statistics clearly clarified that, early and late marriage are causing the severe consequences in health of the women.. Therefore it is important to develop educational programmes to empower the adolescent girls in schools about the consequences of early and late marriage which will be aiding them to select the right choice in life.
1.2 STATEMENT OF THE PROBLEM
" A study to assess the effectiveness of structured teaching programme on knowledge regarding health consequences of early and late marriage among adolescent girls at selected Government Schools, Chennai "
1.3 OBJECTIVES OF THE STUDY
To assess the pre-test level of knowledge regarding health consequences of early and late marriage among adolescent girls.
To evaluate the effectiveness of structured teaching programme [post-test] on health consequences of early and late marriage among adolescent girls.
To compare the pre-test and post- test knowledge regarding health consequences of early and late marriage among adolescent girls.
To find out the association between the post-test knowledge of adolescent girls and selected demographic variables .
1.4 OPERATIONAL DEFINITION
Assess: In this study it refers to find out the knowledge of adolescent girls regarding health consequences of early and late marriage.
Effectiveness: In this study it refers to significant increase in the level of knowledge among adolescent girls regarding health consequences of early and late marriage, which is measured by post-test, structured teaching programme and post-test.
Structured Teaching Programme: In this study it refers to systematically developed programme with teaching aids, design to impart knowledge to adolescent girls regarding health consequences of early and late marriage among adolescent girls .
Knowledge: In this study it refers to the awareness, information, understanding correct response of the structured teaching programme about health consequences of early and late marriage among adolescent girls .
Health Consequences: In this study it s refers to the effect which arises due to early and late marriage , such as anaemia, infertility ,depression, miscarriage, Pregnancy Induced Hypertension, diabetes , isolation, cervical cancer, increased infant and maternal mortality rate ,
Early Marriage: In this study it refers to those who marry below the age of 18 years.
Late Marriage: In this study it refers to those who marry after the age of 30 years.
Adolescent Girls: In this study it refers to adolescent girls between the age group of 13- 15years .
1.5 HYPOTHESES
H1: There will be a significant difference between pre-test and post- test level of knowledge regarding health consequences of early and late marriage among adolescent girls.
H2 : There will be a significant association between the post-test level of knowledge and their selected demographic variables.
1.6 ASSUMPTIONS
Adolescents girls may have some knowledge regarding health consequences of late and early marriage .
Administration of Structured teaching programme on health consequences of early and late marriage will promote the knowledge of adolescent girls.
1.7 DELIMITATIONS
The study is limited to adolescent girls in selected Government Schools, Chennai.
The study is limited to 4 weeks
1.8 CONCEPTUAL FRAMEWORK
A conceptual framework is a process of ideas, which are framed and utilized for the development of a research design. It helps the
researcher to know what idea needs to be collected and gives directio n to entire research process.
Nola J Pender described the Health Promotion model.
HEALTH
According to this model health is defined as a positive dynamic state rather than simply the absence of disease. The persons level of wellbeing is described at the highest level in this model
PERSON
The health promotion model describes Person as multidimensional as they interact within their environment to pursue health.
ENVIRONMENT
The health promotion model describes the areas where the person is in contact as an environment.
FOCUS AREAS OF PENDER’S MODEL
Pender's model focuses on three areas: Individual characteristics and experiences,
Behavior-specific cognitions and affect, and
Behavioural outcomes.
Individual Characteristics and Experiences
The model states that each person has unique personal characteristics and experiences that affect subsequent actions. It also describes that the set of variables for behavior specific knowledge have important motivational significance. In this study individual characteristic includes the demographic variables such as age,
education, occupation, income, religion, type of family, area of living and history of early and late marriage in their family,
Behavour Specific Cognitions and affect
The model describes the behavioural specific cognitions includes the various activities that increases or inhibits the cognitions and understandings that brings the modifications in the healthy outcome. In this study the activities includes the structured teaching programme on health consequences of early and late marriage with the help of booklets, pamphlets and power point presentation. Post-test and post- test will be conducted prior and after the structured teaching programme to assess the level of understandings and gain in knowledge.
Behavioural Outcomes
Behavioural outcome is the end point in the Health Promotion Model. Behaviour specific cognitions will bring adequate gain in the knowledge which results in improved health, enhanced functional ability and better quality of life at all stages of development. Behavioural outcome in this study is expected to have a adequate knowledge on health consequences of early and late marriage. The behaviour outcome may also be moderate or inadequate which may require reinforcement again by education.
FIG. 1.2. CONCEPTUAL FRAMEWORK BASED ON MODIFIED PENDERS HEALTH PROMOTION MODEL
Behavioural Specific Cognition And Affect
Behavioural
Characteristics Behavioural Outcome
PRIOR RELATED BEHAVIOUR
History of early and late marriage in their family
Reasons for early and late marriage
Demographic variables of students
Age,
Type of family
Number of siblings in the family
Education status of parents
Occupation status of parents
Family Income per month
PERCEIVED BENEFITS OF ACTION Students participated in the study perceives after the
teaching programme they will gain knowledge on health consequences of early and late marriage.
PERCEIVED BARRIERS TO ACTION Lack of knowledge, illiteracy, poverty, cultural influences
not knowing the consequences of early and late marriage
PERCEIVED SELF EFFICACY
Students under the study may have knowledge about the consequences of early and late marriage
ACTIVITY RELATED AFFECT After the teaching programme students under the study will gain adequate knowledge and understands
the consequences of early and late marriage
INTERPERSONAL INFLUENCES
Education, occupation and socioeconomic state of their family may influence the health consequences of early
and late marriage SITUATIONAL INFLUENCES
IMMEDIATE COMPETING DEMANDS AND PREFERENCES
DEMANDS
Lack of knowledge, inadequate guidance and practices.
PREFERENCES:
Prevention of early and late marriage
COMMITMENT TO PLAN OF ACTION Structured teaching programme on knowledge
regarding health consequences of early and
late marriage.
HEALTH PROMOTING BEHAVIOUR Students participated in
the study will gain adequate knowledge and FEEDBACK
ASSESSMENT OF POST-TEST LEVEL OF KNOWLEDG
CHAPTER – II
REVIEW OF LITERATURE
This chapter deals with review of literature related to health consequences of early and late marriage
REVIEW OF LITERATURE RELATED TO STUDY
Review of literature is a written summary of the study conducted previously study topic .The review of literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly publication, unpublished scholarly print materials, audiovisual materials and personal communication.
IN THIS STUDY, REVIEW OF LITERATURE WERE CLASSIFIED 2.1.1 Studies related to prevalence of early and late marriage.
2.1.2 Studies related to factors influencing early marriage and late marriage.
2.1.3 Studies related to consequences of early and late marriage.
2.1.4 Studies related to awareness of early and late marriage.
2.1.5 Studies related to prevention of early and late marriage.
2.1.1. STUDIES RELATED TO PREVALENCE OF EARLY MARRIAGE
Zannatul Ferdous etal [2019] conducted a cross sectional study to assess the knowledge and perception of early marriage among adolescent girls in Bangladesh. The sample consist of 120 adolescent girls Data was collected by using semi- structured questionnaire from 10 May to 10 August 2016. Analysis was made by SPSS and spread sheet.
The study result shows there was a statistically significant association between the adolescent age, education, marital status and level of
knowledge about early marriage. The study also reveals the adolescent girls need an adequate knowledge and perception about early marriage and its negative consequences.
Rakesh Balaji Waghmare et al [2018] conducted a cross- sectional study to assess the burden and determinants of child marriage and teenage pregnancy in urban slum area. The sample consist of 382 women at the age group of 15–45 years. Data was collected by face- to-face interview method. Analysis was made by SPSS software. The study result shows that 83.50% of the samples belongs to Musli m , 29.32% had completed their secondary education, and 83.50% were married. The study also reveals that mean age at marriage and at first child birth was less in Muslims, and home deliveries were more in Muslims (35.50%) . The study result also shows that higher number of child marriages, is happened especially among Muslim religion and understudied women. The women those who are living in urban areas are still delivering children in their adolescent age group. The health care provider must conduct a community awareness program for parents regarding the importance of girls‘ education, age of marriage, and law.
Yogita P. Pandya et al [2017] conducted a cross -sectional study in Ardi village of Anand district. The sample consist of 755 married women less than 10 years. The data was collected from August 10th to January 20 th, 2013.The data was collected by semi- coded and post- tested questionnaire. Analysis was made by statistically package for social science. The study result shows that 71.5% of child marriage is due to Caste and spouse's education .. The study result also reveals that there is a significant association between the mother's age at birth of first child and lack of knowledge regarding the health implications of child marriage. The result also shows that child marriage is high in rural
enforcement of legislation ,laws , policies, and educational opportunities for girls to improve their health status.
Mobolaji Ibitoye et al [2017] conducted a systematic review and meta analysis study on sexual and reproductive health in low- and middle-income countries . The sample consist of adolescent girls between the age group of 15–19 years. The data was collected from January 1st to April 9th, 2017. Analysis was made by SPSS and spread sheet. The study result shows that the early menarche is one of the important factor for early marriage and affecting the sexual and reproductive health of adolescent girls. The result also reveals that there is a significant association between the early menarche and early marriage is one of the most important implication for the countries with high child marriage rates.
Rachel Kidman [2017] conducted a comparative study on Child marriage and adult marriage regarding the intimate partner violence among 34 countries and 6 regions. . The sample consist of women aged between 15- 49 years. The sample was randomly selected and the data was collected from the respondents. The data was collected from 2005 to 2013. Data analysis was made by SPSS and spread sheet. The study result shows that 9% of women married before 15, 25% of women married between the age of 15 and 17. The study also reveals that the child marriage is high in Mali 58%,48% of the sample had completed their primary education and 64% of respondents lived in rural area. The study result reveals that 5% of women reported the forms of violence, 17% of women had physical violence IPV, 2%of women reported sexual IPV and 75% of women reported no violence in the past year.
The result shows the women married between 15 and 17 had high risk of physical and sexual IPV in 19 countries.
Farid AW Ghrayeb et al [2015] conducted a cross- sectional study on Prevalence of Early Marriage among Women in Rural Palestinian Community. The sample consist of 500 married women in Yatta. Convenience sampling method was used to select the sample.
Data was collected by structured Arabic questionnaire method. Analysis was made by SPSS. . The study result shows that 41·4% of women marry before the age of 18 years, and 54·6% women married at the age of 18-25 years. The study also reveals that 248[49.6%] of total population had only seven years of education,155 [31%] were non - consanguineous marriage , and they had 211 [42.2%] 7-12 years of education and 128 [25.6%] were consanguineous marriage. Result shows that there is no statistical difference between the husband occupation and early marriage. The result also shows that the prevalence of early marriage and its health consequences can be prevented by developing the policy making and stake holders. Proper educational programme should be made to enhance the knowledge of women and to improve the health status.
Rammohan A, Singh D et al [2015] conducted a study on National Family Health Survey to assess the effects of early marriages and early childbearing on women's nutritional status in India, especially in Andhra Pradesh and Bihar. The sample consist of 109,041, out of 124,385 women aged between 15- 49 years, and 74,369 men aged between 15- 54 years of age. Multi stage sampling technique was used to select the sample. The data was collected from 2005 - 2006. Analysis was made by Multinomial logistic regression method. The study result shows that 60% of married women aged 15 - 49 years were married before the age of 18 years and 50% of currently married women were married before the age of 18 years. The result suggest those women who married at the age of 18 years and above, the prevalence of anemia is
18 years. The level of anemia is decreased with an increase in age at first birth. The study result also reveals that the malnourished women differs considerably by their age, place of residence, level of education and economic status of the family. Improve the nutritional status and health care utilization among women to prevent maternal and child mortality rate.
Sileshi Workineh et al [2015] conducted a community based cross sectional study on determinants Of Early Marriage among Female Children In Sinane District, Northwest Ethiopia. The sample consist of married women less than five years . Stratified multistage sampling technique was used to select the sample. Data was collected by using semi-structured questionnaires. The study was conducted from June to August 2014. The study result shows that 12.2 [95%] times of child marriage is higher in rural area when compared to urban. The study also reveals that the monthly income of the family between 451- 650 were 2.5 times are higher in child marriage when compared to monthly income more than eight hundred. The study also shows that there is significantly associated with place of residence, monthly income of the family, knowledge regarding the legal marital age. The study also reports that the proper awareness educational programme was conducted in the community regarding the appropriate age of marriage and the consequences of early marriage.
2.1.2 STUDIES RELATED TO FACTORS INFLUENCING EARLY MARRIAGE AND LATE MARRIAGE
Ju-Eun Song etal [2018] conducted a analytical study on
"National survey on fertility and family health and welfare" conducted by Korea institute for health and social affairs. The sample was collected from 3,482 married women aged between 19- 39 years. Cluster sampling method was used to select the sample. Data was collected from the respondents by a self report questionnaire methods. Analysis was
made by SPSS method. The study result shows that the factors influencing the women's child birth and their perception on child marriage is due to multiple variables such as place of living, religion, monthly income of the family, perception about the marriage and child birth. The study also reveals that proper financial and political support for maternal and child birth will enhance their positive attitudes to improve the health status of women and to develop their positive attitude.
Richard de Groot et al [2018] conducted a cross sectional study on child marriage and associated outcomes in Northern Ghana district.
The sample consist of 1349 married women between the age 20-24 years. Data was collected by a self instructed questionnaire method.
Analysis was made by SPSS method. The study result shows that the child marriage is associated with poor health, economic status of the family and increased child mortality rate. The study also shows that the health care provider should promote health education regarding child marriage to enhance the knowledge of women regarding child bearing, child mortality, and reduced stress rate.
Akanksha A. Marphatia et al [2017] conducted a perspective study on women's marriage age and social implications in South Asia.
The marriage is due to geographical region, cultural and religious condition. marriage is very essential in both the sex and strong social sanctions for child bearing. The study shows that about 90% of women aged 15- 49 years were married by the age 25- 29 years. The study also shows that the lower status of women, social issues, biological, ecological and geographical factors will result in early marriage. proper utilization of policies and interventions helps the women to enhance the knowledge regarding the consequences of marriage.
Kazutaka Sekine et al [2017] conducted a cross sectional study on effect of child marriage on girls' school dropout in Nepal. The sample consist of 14,162 women of reproductive age between 15–49 years. Stratified random sampling method was used. Data analysis was made by descriptive and logistics regression method. The study result shows that the early marriage is due to school dropout, lack of education, religion, and place of residence. The study also reveals that the child marriage is significantly increases the girls risk of school dropout in Nepal. The study also says that there is a significant association between the child marriage and their religion. The health care provider would conduct the school- based programmes in preventing the child marriage and to improve their educational status of women.
Oxford university press USA report [2016] conducted an epidemiological study on the connection between child marriage and domestic violence . The sample consist of Women aged between 15-49 years . Randomly selected sample was used to select the sample. Self instructed questionnaire method was used. The study result shows that there are number of potential reasons for child marriages and it is characterized by greater violence. The study also reveals that the women who marry early as children and they are more likely to be uneducated, poverty, and traditional gender norms. The study also shows that the child marriages are characterized by spousal age gaps, power imbalances, social isolation, and lack of female autonomy. The result shows that the inequitable gender norms give rise to child marriage and domestic violence. Proper educational programme will enhance the knowledge of women regarding consequences of early marriage.
Jennifer Roest [2016] conducted a descriptive study on risk factors of child marriage and early child bearing in India. The sample consist of married women less than 18 years of age with low socio - economic status. The study result shows that the early marriage is common in backward classes those who are living in rural area when compared to urban area. The study also reveals that the girls who marry early were less likely completed their secondary education, 40 per cent of the girls who experienced child marriage were still in school, when compared to 86 per cent of the girls who were still unmarried when they were 18 years. The study also shows that the girls who made delayed marriage beyond the age of 18 years had scored consistently higher in maths and Peabody Picture Vocabulary Tests when compared to their married peers.
Simin Montazeri,et al [2016] conducted a qualitative study on determinants of early marriage and their perspectives on Iranian v illage.
The sample consist of 15 married women who are attending health care centers. Purposeful sampling method was used to select the sample. The study was conducted from May 2013 to January 2015. The data was collected from the sample by semi structured and face-to-face interviews method. The study results shows that the participants of early marriage is due to unexpected and stressful event and they were unprepared to accept the roles and responsibilities of marriage. The study also reveals that most of the participants are intended to postpone their marriage until completion of their education, cultural family structure, low authority, response and decision making and propelled them to marry. These study findings also shows that the implications for policymakers, planners, and health practitioners helps to develop culturally sensitive programs and interventions of teenage girls. These programs also helps the girls to empower for proper
study also shows that early marriage is a multifactorial problem, an inter sectoral approach should be made to develop and to implement effective and comprehensive programs in raising awareness among families and communities regarding the negative consequences of early marriage.
A.K.M. Fahmidul Haque [2015] conducted a cross sectional study to assess the knowledge, approach and status of early marriage in Bangladesh. The sample consist of 300 eligible couples of reproductive age. Data was collected by structured questionnaire with face to face interview. Analysis was made by SPSS and standard deviation method.
The study result shows the rate of lack of knowledge, illiteracy rate, and economic status of the family will induce early marriage. The study also reveals there is a significant association between age of early marriage and occupation of the respondents with p value 0.034. The study showed specifically to give more attention to this issue to graduate least development country and to improve health status of women.
2.1.3 STUDIES RELATED TO CONSEQUENCES OF EARLY AND LATE MARRIAGE:
Jacqueline E.W.Broerse [2017] conducted a qualitative study in which the author assess the knowledge regarding maternal health care - seeking behavior of married adolescent girls in Bangladesh.The sample consist of 30 married adolescent girls residing in three sub-districts of Rangpur. Purposive sampling method was used to select the sample.
Data analysis was made by social- ecological model[SEM]. The study result shows that the adolescent girls has less knowledge and perception about marriage, pregnancy and delivery care shapes the use of skilled maternal health services. The study also shows the quality of maternal health services is important in building the trust among young rural women. A special attention should be given to adolescent girls and family members to make good and proper decision making in marriage
and skilled maternal health services. Community leaders and health care provider plays an important role in married adolescent girls and their family members by informing about the health consequences of early marriage and pregnancy.
Mrs. Nice Joseph [2017] conducted a quasi experimental study in which the author compares the pre-test and post -test knowledge of students regarding health consequences of early and late marriage in Ankola, Uttar Kannada District, Karnataka. The sample consist of 30 students studying in Vishwadarsan School of Nursing. Simple random sampling technique method was used to select the sample .The study shows that the mean post-test knowledge score (18.19) was normally higher than the mean pre-test knowledge score (14.13). The study also shows that there is significant difference between the pre-test and post- test knowledge scores. (t=7.783, p< 0.05). The pre-test knowledge scores were independent of all the demographic variables except the education of the mother .The study also reveals that the BCC [Behaviour Change Communication] helps the adolescent girls, Women and mothers those who are living in rural or urban imparting their knowledge regarding health consequences of early and late marriage
Shubha devi sapkota etal [2017] conducted a quasi experimental study to compares the pre-test and post-test knowledge and attitude regarding teen- age pregnancy among adolescent girls in Bangalore..The sample consist o 60 early adolescent girls. Randomly selected method was used to select the sample. Analysis was made by descriptive statistics and inferential statistics method. The study result reveals that the pre-test knowledge and attitude was 45.5%,66.4%.Whereas in post - test 78.3%,86.0% and the mean difference was 32.9%, 19.6%. The study also shows that there is a significant difference between the pre -test and
Tania Fitzgeorge-Balfour etal [2017] conducted a descriptive study on mental health among early married adolescent girls in Kurumbalur village, Perambalur district. The sample consist of 40 adolescent girls who married before the age of 18 years. Convenient sampling method was used to select the sample. Data was collected by self instructed questionnaire method. The study result shows that most of the respondents belongs to the age group 16 years, had completed primary education, majority of the sample were belongs to Hindu religion,65% of the respondents belongs to scheduled caste community.
The study also shows that 90% of respondents lived in rural area and they are earning monthly income of Rs 5000- 10,000 per month. The study also revealed that the majority of the respondents have completed their medium level education ,of overall mental health, more than one third of the respondents have very low level of overall mental health and remaining 2.5% of the respondents have high level of mental health. The study concluded that very low percent of the respondents have high level of mental health and the remaining have low mental health status.Proper awareness programme should be made to stop early marriage. The adolescents girls should not be burdened with too much of responsibilities and so many complicated family commitments. It will affect them both physically and mentally. Proper guidance and counseling should be given to parents and family members regarding consequences of early marriage and their healthy future of their children.
D. Koteswaramma [2016] conducted a pre- experimental study to assess the effectiveness of structured teaching programme on hazards of teenage pregnancy in adolescent girls in junior college Tirupathi, India. . The sample consist of 50 teenage girls. Data was collected by self administered pre-tested questionnaire. The study result shows that 66%
of adolescent girls are receiving information from mass media, and 28%
of girls are receiving information from their teachers about teenage pregnancy. The study also reveals that the students have not received any information from their parents and health team members. The pre - test knowledge is 16.98, improve after imparting education of post-test 57.84 which is significant at 0.01 level. The study also shows that Nursing personnel and health care provider can conduct counselling and educational sessions at colleges to prevent teenage pregnancy.
India TV Lifestyle Desk [2016] recent reports, says that the late marriages, and late pregnancy have contributed to incidence of cancer among women, The report stated that 46% of women suffering from cancer are under 50, which is a worrying trend that's likely to continue in the coming years due to lifestyle changes."Two per cent of the Indian women suffering from cancer are in 20 to 30 years age group, 16 per cent are in 30 to 40, 28 per cent are in 40 to 50 age group. So, almost 46 per cent women patients are below 50," said Sameer Kaul, Senior Consultant of Surgical Oncology at Indraprastha Apollo Hospital to a leading daily .He said an increasing number of patients belong to 25 to 40 years of age, which is an "alarming" situation.
Bulut Kasım etal [2015] conducted a study which show the marriages are going on to keep their commonness in countries such as Turkey although frequencies of them are decreasing in the world. The study, shows that 19 girls, who were being married at early ages and psychologically examined between January 1st, 2013-April 1st, 2015 in physical and mental health committee of the Dicle University, Medical Faculty, were taken to evaluate that social, educational and legal solutions to prevent early marriages should be sought; girls and their families should be trained accordingly and mental therapies of the victim girls should be performed rigorously.
Sofia Naveed et al [2015] conducted a perspective study on causes and consequences of child marriage in South Asia. The sample consist of 30 married women before the age o f 18 years. convenient sampling method was used to select the sample. Self instructed questionnaire was made. The study result shows that the early marriage is due to poverty, illiteracy, and gender inequality. The study also reveals those who marry early had completed their primary and secondary education and high rate of physical, psychological and emotionally affected. Health care provider should conduct educational programmes regarding and to enhance knowledge of women regarding the consequences of child marriage.
K.G.Santhya [2015] conducted a qualitative study to find out the association of pre-test knowledge score and selected demographic variables in rural and urban area of Andhra Pradesh, Bihar, Jharkhand, Maharashtra, Rajasthan, Tamil Nadu. To find out the association between early marriage and young women's marital and reproductive health outcomes. The sample consist of 138,000 out of 42,852 were married men, 9,856 unmarried men, 11,905 were married women, 14,361 were unmarried women. Multi stage stratified sampling method was used to select the sample. Logistic regression analyze was used to identify the association between the early marriage and their health outcomes. The study result shows that the association between young women who married early at the age of 18 yrs were less educated, never attended school those who married late. The result also shows that the women who married early have increased physical violence, sexual violence, miscarriage or still birth compared to late marriage. The study also reveals that they need some physical support to build the youth, adolescent and their families for delay marriage and to enforce certain laws, encourage school going youths, and the benefits of appropriate marriage, to support the women and families to delay marriage.