By: Nadia Diamond-Smith

“…our life becomes imprisoned. We have to live like a prisoner…I mean like a chained animal. When you can’t do whatever your heart wishes, when you can’t go wherever you want to go”

This is a reflection from a young, newly married woman in rural Nepal about her life after getting married. It sums up perfectly observations in the villages in which our team worked for the last five years. Some young, newly married women would not even stand in the doorway of their homes for fear of being seen by someone outside of her home. Starting in 2017, our team collected triadic qualitative interviews with young (<25 years), newly married women, their husbands, and mothers-in-law, followed by a two-year longitudinal observational study with 200 newly married women. We found that in the first four months after marriage, only half of the newly married women had ever left the house. Limited mobility was deeply intertwined with other forms of low status, especially around access to food and order of household eating. In our study, half of the newly married women reported that they ate last always or most of the time and almost all were not meeting minimum dietary diversity standards. In this setting, as in much of South Asia, arranged marriages are still pervasive, and newly married women move into their husband’s family’s home, often living with his parents. This leads young couples to not know each other well in the formative years of marriage, and young women often find themselves in a new household without strong relationships. Women in our study reported low levels of communication with their husbands, with less than half of wives reporting having discussed the number of children they wanted with their husbands and a third feeling comfortable talking to their husbands about sex in the early days of marriage.

Based on these findings, our team, which was comprised of the Center for Research on Environment Health and Population Activities (CREHPA), a research organization in Nepal, the Vijay Development Resource Center (VDRC), a community-based organization in Nawalparasi district of Nepal, and the University of California, San Francisco, worked closely with a community advisory board through a community-engaged process, to develop Sumadhur, meaning “Best Relationship”. The four-month long weekly group intervention engaged newly married women, their husbands, and mothers-in-law, and included education on nutrition, food allocation, prenatal care, pregnancy care, fertility and family planning, household relationship dynamics, and gender inequitable norms, along with interactive games and activities. Through this community-led, co-developed intervention, we hypothesized that strengthening marital bonds and addressing household gender dynamics would improve newly married women’s status, mobility, and access to food.

However, we had many lingering questions—would households allow their newly married brides to attend? Would other household members make time for this? How would they feel engaging in these sensitive topics with other members of their community? Would they play games and activities on these sensitive topics? Would it make a difference?

In early 2021, during the COVID-19 pandemic, we piloted the intervention and were enthused by the eager participation of the community members and households. We found that Sumadhur was acceptable and loved by the participants. Despite initial hesitancy about combined sessions with husbands, mothers-in-law, and newly married women, most women reported that it felt good to attend a session with their in-law. As a result of the intervention, nutritional knowledge and practices improved. There was increased awareness of the need for preconception, pregnant, lactating, or postpartum women and adolescents to eat more. Eating patterns also shifted, with a decline in the number of daughters-in-law reporting that they ate last and an increase in the proportion reporting that the household ate together usually or all the time.

In the interviews, participants reported that they enjoyed the group dynamics and saw the value in bringing people together. Moreover, the intervention addressed social and gender norms and led to changes in household relationships and behaviors:

I felt comfortable to be in a group. There were other members with whom we could interact and know them better. Had it been only my family in the training, it would have been less interactive….. Also, it is very important to give training to community members as well. Here, the community follows traditional practices. I think such training programs will help to change their thought process….. In our community, daughters-in-law cannot come outside freely, woman cannot go outside their house to work, mothers-in-law and daughters-in-law don’t interact much etc. Such things need to be changed. It was somewhat similar in my household as well. But after the training it has changed a little. As I said earlier, we eat together and interact much more than before. My wife and my mother interact more and this makes me feel good. (Husband)

Despite our anxiety that families wouldn’t allow their newly married daughters/wives to leave the home to participate, newly married women described how the intervention gave them the opportunity to leave their homes, and this gave them more voice and confidence.

I had not stepped outside of my home post marriage. I felt very happy to step outside of my home to attend this program. You learn some new things when you step outside of home. Attending program has increased my knowledge, I came to know about many things. I have also developed confidence for speaking. This kind of program raises awareness among people. I am very happy to be a part of this program (Wife)

An unexpected finding was the impact that the program had on mother-in-law’s empowerment, alongside the hoped-for changes in knowledge and strengthening of household relationships.

Going together with my son and daughter-in-law, I came to know many things. It was easier for me to go together with my son and daughter-in-law. I would have been shy to talk too if I had gone alone, but going together with them became easier for me…..I have felt changes even if it’s a little. There are changes in everything regarding behavior of the family members, working environment, eating habit, conflicts. I had always wondered how would my daughter-in-law be. As she was recently married, I had not known her well. I got an opportunity to know her while going to the program. We used to go together, talk on the way and discuss about the things discussed after we would come back. We perform household work together, talk to each other and share our things. I had a negative attitude towards daughter-in-law earlier which has changed now. My daughter-in-law treats me well and so do I. (Mother-in-law)

These are but a handful of quotes and findings from this multi-faceted intervention. Overall, we were overwhelmed by the positive response from the community, and the willingness of young newly married couples and their households to engage with each other and others in their community and challenge long standing restrictive norms such as order of household eating and limited women’s mobility. Social and gender norms are often seen as immovable, or, at least, very hard to shift—however, we found that people were open to, and in many cases ready to embrace change. Subsequently, this relatively short and low-cost intervention that was designed with the community and that addressed individual, household and community level norms, led to changes in behavior, and, perhaps more importantly, brought joy and closeness to newly married women and their families during this formative phase of their lives.

To learn more, check out the full paper related to this blog here.

About the author:

Nadia Diamond-Smith is an Assistant Professor in Epidemiology and Biostatics and The Institute for Global Health Sciences at UCSF. Her research is at the intersection of gender equality/women’s empowerment and reproductive and maternal health, with a focus in South Asia.