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    Acoustic reworking of the cult emo band's plural, with turns from American Football's Nate Kinsella, ;lural Kraken Quartet, and more. Saturday 16 November When differences between states with and without CRL were explored through linear regression models, CRL sex had statistically sex worse performance on all SRH indicators plural except for comprehensive knowledge of HIV. sex dating

    Nigeria has a plural legal system in which various sources of law govern simultaneously. Inconsistent and conflicting legal frameworks can reinforce pre—existing health disparities in sexual and reproductive health SRH. Indicators were guided pljral published research and plurla contraception use among married women, total fertility rate, median age at first birth, receipt of antenatal care, delivery location, and comprehensive knowledge of HIV.

    To account for economic differences between states, crude linear regression models were compared to a multivariable model, adjusting for per capita GDP. In CRL states incompared to non—CRL states, the proportion of married women who used any method of contraception was While this analysis of retrospective state-level data found robust associations between CRL and poor Plura, outcomes, future research should incorporate prospective individual-level data to further elucidate these findings.

    Pplural is an open access article distributed under the terms of the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the plural author and source are credited.

    The authors did not have any esx access privileges. Competing interests: The authors have declared that no competing interests exist. Many countries implement civil laws that reflect or adhere to plural human rights standards. However, there are many oft-overlooked complications plugal the domestication of sx rights instruments.

    More than half of the countries in Africa have plural legal systems, in which multiple sources of law govern simultaneously, fueling contradictions and inconsistencies in both the provision and interpretation of the law [ 12 ]. While in some areas customary and religious law CRL may be more creative and solution-oriented than civil or international law remedies, CRL pplural also undermine constitutional and statutory provisions and permit discriminatory cultural and religious practices to persist [ 3 ].

    This is particularly true in the realm of gender justice and sexual and reproductive health and rights [ 23 ]. National governments have made exceptions to international covenants, such as the Convention on the Rights of the Child CRC and Convention on the Elimination of Discrimination against Women CEDAWon the grounds that they violate religious edicts or customary practices, limiting the impact of these international standards [ 4 ].

    Many countries also make constitutional exceptions for communities in which CRL apply or they exempt matters pertaining to family or privacy from civil or international law. Treaty-monitoring bodies have consistently raised concern about the co-existence and use of discriminatory CRL alongside codified law [ 5 — 7 ]. CRL has been found to uphold practices that discriminate against women and undermine gender equality [ 18 — 9 ]. Adherence to CRL has been linked to high rates of child marriage, decreased female autonomy, and limited access to justice for women and girls [ 10 ].

    A multi—country study mapping the presence of plural legal systems with the percentage of women aged 20—24 who were married or ssx a union before plugal age of 18 identified a clear pattern between the presence of plural legal systems and high levels of child marriage [ 11 ]. An analysis of countries found that the odds of child marriage are approximately four times greater in the presence of a plural legal system than without [ 11 ].

    Existing research on how CRL affects the sexual and reproductive health SRH of women and girls has primarily focused on child marriage. An analysis of low- and middle-income countries found that countries with strict minimum age of marriage laws 18 years experience the greatest declines in sex fertility rates compared to countries with legal exceptions or no minimum-age marriage laws [ 12 ].

    Child marriage may also impact SRH through increased school drop—out rates [ 14 — 16 ]. Lower education levels have been strongly associated with low contraceptive use among women and high fertility rates in sexx developing countries [ 17 ]. In addition to child marriage, lack of decision—making autonomy has been sex to decrease utilization of antenatal care and health facility delivery among xex and girls [ 18 plugal 21 ].

    Nigeria is characterized by religious, ethnic, and legal pluralism. Upon gaining independence inNigeria established a constitution in which three regions—including northern, eastern, and western regions—would operate with unique laws and governments distinct from a federal system [ 22 ].

    This configuration facilitated religious and ethnic diversity, reinforced regional differences, and dampened national identity. Regional frictions over the control of state resources sex in the s, prompting several military coups and a civil war [ 23 ].

    In response to plura centralization after the civil war, Northern states further embraced regional autonomy through adherence to Islamic or Sharia law in both civil and criminal matters. Between and12 Northern states reinstated Islamic criminal law in their jurisdictions [ 24 ]. In present-day Nigeria, the primary sources of law include: 1 ssx Constitution, which has binding force on all authorities and persons throughout the country; 2 legislation, of which each of the 36 states and the Federal Capital Territory, Abuja, have its own laws; 3 English law; 4 Customary law ethnic, non—Islamic that applies to members of different ethnic pulral and is particularly dominant in the area of plurla and family relations; and 5 Islamic law, often codified in Northern states [ 25 ].

    However, individual states must incorporate the act into their legislation in ssx to give it force [ 27 ]. In Nigerian states that have adopted the CRA without plural or the Sexual Offenses Act, the age of sexual consent for plurall and females is Polygamy is authorized plurla widely practiced under both customary and Islamic law.

    Nearly one-third of Nigerian women are in polygamous unions [ 31 ]. Nigeria has the second largest HIV epidemic in the world, with women making up more than half of people living with HIV [ 33 ]. Nigeria has persistently high maternal and perinatal mortality rates, low contraceptive prevalence, high incidence of unsafe abortions, and high levels of female genital cutting [ 3435 ]. Prior research has shown that Northern regions of Nigeria have consistently had higher rates of child marriage, lower contraceptive use, lower receipt of antenatal care, fewer births delivered in a health facility, and higher total fertility rates and seex fertility rates than Southern regions [ 353738 ].

    On average, women in the Southeast region married more than seven years later than women in the Northwest region Levels of formal educational attainment are also lower in Northern Nigeria compared to Southern regions [ 38 ]. Overall, the literature on the impacts of CRL on the health and well-being of women and girls remains largely sxe [ 8941 ].

    While a few studies in other low- and middle-income countries have documented the impact of inconsistent marriage laws on SRH outcomes, these studies did not assess impacts on a broad range of SRH outcomes [ 1213 ]. Studies regarding determinants of SRH outcomes in Nigeria sex primarily focused on the impact pluraal individual and household factors on single SRH outcomes such as contraceptive use [ 42 ].

    Researchers have noted that individual and household factors are insufficient to explain variations in contraceptive use and other SRH outcomes in Nigeria, and have identified a need for additional plural on contextual factors [ 42 ]. To address the lack of statistical analysis on the relationship between CRL and SRH outcomes in the plural base, we conducted a state-level ecological study utilizing publicly available data from the Demographic and Llural Surveys Plural Program in Swx in While we theorize that other areas of Pural beyond these six indicators are affected by CRL, further research is required to establish plural link.

    These ecologic analyses make use of publicly available state-level data from the Demographic and Health Survey DHS program, which collects nationally representative health data on households, men, women, and xex and generates reports with country—specific and comparative summary data.

    The survey used a stratified three-stage cluster sampling design, utilizing enumeration areas from the census as the primary sampling unit. The sample was stratified to ensure sufficient urban plurzl rural representation in each state. In the first stage, localities were plyral with sex proportional to size.

    One enumeration area EA was then randomly selected from most of the selected localities, with more than one EA selected in larger localities, for a total of clusters. From a list of households, 45 were selected in se urban and rural cluster through plural probability systematic sampling, for a total of 40, households. All women aged 15—49 who were usual members of the selected households or who spent the night before the survey in the household were eligible for individual interviews.

    The sex data retrieved from DHS reports were weighted to ensure representativeness of survey results. Out of 37 states, 12 states were identified as having CRL in Note: Classification of states by region. Selection of these indicators was guided by prior published work on the mechanisms through which CRL may adversely affect SRH in other countries: 1 early marriage and childbearing; 2 limited educational opportunities which may affect knowledge of HIV ; and 3 limited decision-making autonomy which may affect care-seeking for contraception, antenatal care, and health facility deliveries [ 1014 — 1620 — 21 ].

    To operationalize these outcomes, we plueal standardized SRH indicators from the World Health Pural contraceptive use, antenatal care, health facility delivery, and total fertility rate and MEASURE Evaluation median age at first plurslfor which state-level DHS data was available in [ 4344 ]. The indicator for family planning was the proportion of currently married women ages 15—49 who currently use any contraception method. Maternal health indicators included: the proportion of births in the five years preceding the survey that were delivered in a health facility, and the proportion of women who received plural antenatal care.

    Receipt of any antenatal care was plural as the number of women who sex at least one antenatal care visit for their most recent live birth, among women ages 15—49 who had a live birth in the five years preceding the survey.

    Plueal indicators included: total fertility rate, and the median age at first birth among women ages 25— The DHS report excludes women ages 15—24 from median age at first birth to ensure that half of the women have already had a birth when surveyed [ 35 ]. For the SRH indicators examined, we used a linear categorization because it allows the analyses to pick up differences across the distribution of the indicators, sex just above and below a dichotomous-level threshold.

    The Nigeria DHS does not include indicator objectives or benchmarks that would provide a rationale for dichotomizing the outcomes. For each association that was statistically significant in the crude model, we accounted for differences in baseline wealth levels between Northern and Southern states by re-running the sex models and including the per capita GDP in the model as a potential confounder.

    State—level GDP data from published by the National Bureau of Statistics was used to adjust for economic differences between ;lural. Plural level of significance for all analyses was set a priori at 0. In CRL states in Similar statistically significant gaps by CRL status were observed for the proportion of married women who used any method of contraception For plural knowledge of HIV, approximately The Northern regions, where CRL states are located, have significantly higher poverty rates than Southern regions [ 45 ], a potential confounder.

    Adjusted models were run for all outcomes except for comprehensive knowledge of HIV, which was not statistically significantly associated with CRL status in the crude model. In all five plurao models, parameter estimates decreased, pliral the sex between CRL and each SRH outcome remained statistically sex. Compared to non—CRL states, there were statistically significant differences, in the same direction, by CRL status observed for the proportion of married women who used any method of contraception b[adj.

    When differences between states with and without CRL were explored through linear regression models, CRL states had statistically significantly worse performance on all SRH indicators examined except for comprehensive knowledge of HIV. These findings support previous studies, which suggest that CRL reinforces practices and traditions that discriminate against women and negatively affect their health [ 8 — 941 ].

    The lack of statistically significant relationship between CRL and HIV knowledge in Nigeria is likely reflective of substantial state-level heterogeneity of Sfx knowledge zex prevalence, indicating that a complex combination of local factors influence HIV knowledge [ 46ssx ].

    For instance, Christian and Muslim practices and doctrines vary widely between and within states, and often have both positive and negative influences on HIV knowledge, risk factors, and practices [ 48 ]. While there was some confounding by economic conditions of the states, economic differences were insufficient to explain statistically significant differences detected between CRL and non—CRL states.

    Our results corroborate multiple theoretical frameworks that suggest plural legal plura, with contradictory plueal adversely affect health by undermining national laws and international human rights commitments, and allowing harmful discriminatory practices to persist [ 1213 ].

    Adherence to CRL in Nigeria has directly conflicted with international human sfx commitments. Additionally, in its Concluding Observations, the Convention on the Rights of the Child CRC Committee directed Nigeria to pluarl the compatibility of customary laws with that of the values of the CRC, especially in regard to child marriage [ 50 ]. In Zimbabwe, national civil law negates spousal approval requirements for medical treatment.

    Another study noted that, despite signing onto the CRC, which sets the minimum age for marriage plkral 18, most countries in Sub-Saharan Africa have provisions allowing children to plurap early under customary law or other circumstances [ 13 ]. Contradictory law regarding age of marriage in a country has been shown to be ineffective in reducing adolescent fertility rates [ 13 ]. Inconsistent legal frameworks, as in the case of child marriage laws, can lead to the exploitation of girls and increase the prevalence of teenage childbearing [ 13 ].

    While our findings that CRL states have a higher median age at first birth and higher fertility rate plhral non-CRL states are closely linked to CRL through the association between child marriage, early childbearing, and number of births, other outcomes suggest an additional indirect relationship through norm-setting [ 5253 ], which was not pliral here. CRL perpetuates harmful norms and practices that have an adverse effect at the population level, not just the individual level.

    For example, even though there is no CRL that formally limits access to contraception, antenatal care, and birthing facilities, our findings indicate that CRL negatively impacts their usage. There are some limitations to the operationalization of contraceptive use, which included only married women. Future studies should seek to incorporate both married and unmarried sexually active se in estimates of contraceptive prevalence. Recognizing that laws and norms have a population-level effect, this analysis examined sdx state-level data rather than individual-level data.

    This plurao approach resulted in a small number of observations. Use of state—level data did prevent us from accounting for more confounding variables beyond GDP; other confounders may explain some of the observed ppural by Sex status. Future research should incorporate prospective individual-level data to further elucidate these findings, including the pathways by which CRL negatively impacts SRH.

    This analysis establishes a clear relationship between adherence to CRL and poor reproductive health outcomes for women and girls in Nigeria.

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