‘I thought if I marry the prophet I would not die’: The significance of religious affiliation on marriage, HIV testing, and reproductive health practices among young married women in Zimbabwe

Abstract

This study examines the association between religious affiliation and reasons for marriage, perceived church attitudes, and reproductive health-seeking behaviors, including HIV testing, among young women in eastern rural Zimbabwe. The sample comprised women (N = 35) who had married by 2012 while participating in a larger randomized controlled trial (RCT) to test the effects of school support on HIV-related risk. The RCT sample was identified in 2007 as all female sixth graders in 25 rural eastern Zimbabwe primary schools whose parents, one or both, had died (N = 328). In our previous RCT analyses, we found that participants who affiliated with an Apostolic church were more than four times more likely to marry than those from non-Apostolic churches and that control group participants were twice as likely to marry as those in the intervention group. Other studies had found that marriage greatly increased the odds of HIV infection among adolescent women. Given the link between Apostolic affiliation and marriage, we conducted semi-structured interviews to explore type of marriage, reasons for marrying, church affiliation and attitudes, family planning, HIV testing, schooling, and family life. We were interested in differences, as perceived by our sample of young married women congregants, among Apostolic sects and other denominations in their attitudes about marriage and health-seeking behaviors. We were also interested in the influence of church affiliation on intervention participants’ decision to marry, since they had comprehensive school support and education is highly valued in Zimbabwe, but costly and often out of financial reach. Interviews were conducted from October 2012 through November 2013; data were analyzed using a general inductive approach. We found that pressure or perceived deception for coitus or marriage was reported only by intervention participants affiliated with Apostolic denominations. Other reasons for marriage were similar between Apostolic and non-Apostolic adherents, as well as intervention and control conditions. All participants believed HIV testing was important, but while all non-Apostolic denominations encouraged HIV testing and clinic/hospital care, there was considerable heterogeneity in attitudes among Apostolics, with ultraconservative denominations most likely to proscribe non-religious health care. We conclude that some, but not all, Apostolic-affiliated women are afforded discretion in their health-seeking behaviors. Since HIV screening and treatment depend on access to clinic/hospital care, continued public health efforts to engage Apostolic leaders is needed, along with monitoring of progress in access and outcomes.

How gender and religion impact uptake of family planning: results from a qualitative study in Northwestern Tanzania

“…Our study illustrates the major dual influences of gender and religion on the dynamics of family planning in a region of rural sub-Saharan Africa, and contributes to a growing body of knowledge demonstrating how these factors shape engagement with family planning resources [18, 19, 25]. Our findings are congruent with other studies that have described how gendered roles lead to conflict between partners because the domain of family planning is regarded as “a woman’s matter”, though men are still considered decision makers at the household level (including use of family planning) [6, 26, 27].…”

Correlates of Child Marriage in Zimbabwe

“…While there is a multiplicity of Apostolic sects in Zimbabwe, the largest sects are the Johane Marange and Johane Masowe sects. These rapidly growing and influential African independent churches blend Western Christian beliefs with norms and practices derived from African culture and traditional belief systems (Hallfors et al, 2016). The practice of child marriage is entrenched in the belief system of its members, and children could be married from puberty.…”

“…In Zimbabwe, as elsewhere, child marriages are shaped by a complex interplay of cultural and religious norms, practices, and customs; individual- and household-level factors; and broader political economy factors. Adolescents enter early or forced marriage because of the traditional or religious beliefs of their parents and communities, or economic circumstances (Bassett & Mhloyi, 1991; Hallfors et al, 2016). The economic status of households, in particular extreme poverty or lack of economic opportunities, may also push some families to marry off teenage daughters as a way to reduce economic burdens, such as paying school fees and health care services.…”

Concurrent advanced HIV disease and viral load suppression in a high-burden setting: Findings from the 2015–6 ZIMPHIA survey

“…In this paper, we present a profile of the sub-population of Zimbabwe's PLHIV with AD by laboratory marker (CD4 <200), and in particular, the relationship between AD, VL status and duration on ART. Given reports that health-seeking behavior and outcomes among certain populations in Zimbabwe may be a function of their religious affiliation [13,14], we also explored this in relation to the AD population.…”