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Cohabiting — either as a married couple or as partners in the same household — can prolong your life, according to research carried out in South Africa and published in a report last month. [1] The study, which surveyed 89,000 people in KwaZulu-Natal over ten years, claims to add to the body of evidence worldwide that family relationships and partnerships are important determinants of health and health behaviours. Experts commented that the study had major implications for health policies in South Africa and beyond. 

“Health policy should not be based on universal conclusions about nuclear family life.”

Henrietta Miers

Relationships undoubtedly benefit health and prolong life for many people worldwide. But let’s not forget those women for whom the opposite is the case. For millions of women, nuclear domesticity can be detrimental to health, and even deadly. Their experiences underline the importance of treading carefully when designing health policies, and being aware of the dangers of blanket statements about correlations between relationships and health. 

As many as 38 per cent of murders of women are committed by intimate partners, according to a report by the World Health Organisation published in 2013. [2] The same report found that 30 per cent of women worldwide who have been in a relationship have experienced physical or sexual violence from their partner.

In developing countries, one in three girls is married before she reaches 18 years of age and some are as young as eight or nine. Child brides are particularly at risk of violence — sexual or otherwise — from their partners or partners’ families, and are likely to endure early pregnancies as well. A girl under 15 is five times more likely to die in childbirth than a grown woman.

In exile, child marriages tend to increase, either as a means of protecting daughters in unfamiliar surroundings or out of poverty. Amongst the Syrian refugee communities in Jordan, for example, the proportion of marriages involving a child bride rose from 12 per cent in 2011 to 31 per cent in 2014. [3] A report by UN Women identified the practice of temporary marriages amongst Syrian refugees in Jordan, citing an example of older Saudi and Jordanian men visiting a camp, sometimes leaving with a bride as young as 13, then returning her later. [4] There are also many studies that reveal women’s lack of autonomy over how and where to seek health care. In Pakistan, for example, where wives normally need permission from their husbands to go to a health service, research in urban squatter settlements found that 35 per cent of female respondents said their husbands were against them seeking antenatal care. [5]

Health policy should not be based on universal conclusions about nuclear family life. I am sure there are many women around the world who, if given a choice, would choose to live alone or in alternative domestic arrangements that give them better protection than the conventional nuclear set up. Policymakers and others would do well to heed these nuances when designing health policies and services.
Henrietta Miers has worked across Africa and Asia as a gender and social development consultant for 20 years, specialising in gender policy. She is senior associate of WISE Development, a consulting company that focuses on boosting economic opportunities for poor women.


[1] Melanie Channon and others  A longitudinal population-based analysis of relationship status and mortality in KwaZulu-Natal, South Africa 2001–2011 (Journal of Epidemiology and Community Health, 2015)
[2] Global and regional estimates of violence against women (WHO, 2013)
[3] A study on early marriage in Jordan 2014 (UNICEF, 2014)
[4] Gender-based violence and child protection among Syrian refugees in Jordan, with a focus on early marriage (UN Women, 2013)
[5] Sabeena Jalal and others Ante Natal Care (ANC) seeking behaviour among women living in an urban squatter settlement: results from an ethnographic study (IJPH, 2011)

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