Effects of Premarital Medical Examination on Engaged Endogamous Couples in Rural Lebanon

Abstract

This article discusses the findings of a survey of Shiite Muslim engaged couples to assess their knowledge of the risks of congenital disease in endogamous marriage and the importance of the premarital medical examination. The engaged couples live in the Chmistar and Tarayya villages, located west of Baalbeck, in Lebanon. In-depth interviews were conducted with a group of mothers and key informants (religious leaders, general practitioners, geneticists, biologists and social workers) who are charged with providing information on the risks of marriage between first cousins. The qualitative analysis of their discourse revealed that: (i) endogamous marriage is preferred and fulfills the normative social tradition, and (ii) premarital medical examination, as practiced, seems to give the engaged couple a false sense of security. Results of this research emphasized that a health promotion program aiming at responding to a 1000-year-old tradition, such as endogamous marriage, should take into account the potential conflicts it introduces concerning the anthropological and sociological bases typical of this practice.     

Editor's Comments

There are two purposes of this marriage education marketing study: (1) to compare the self-reported intra- and interpersonal qualities of 121 married couples (n = 242 individuals) attending a marriage education program with 46 married couples (n = 92 individuals) who were contacted through marketing promotional materials to attend the program but did not participate and (2) to determine if intra- and/or interpersonal qualities would predict the likelihood of marriage education attendance versus nonattendance. Results showed that compared with program nonparticipants, program participants reported lower levels of self-esteem, marital communication quality, marital commitment, marital satisfaction, family strengths, less consensus and intimacy, less fulfillment of marriage expectations, and increased levels of marital conflict. Levels of religiosity and fusion were the same for participants and nonparticipants. Wald logistic regression analysis indicated communication was the only significant predictor of marriage education participation. Implications for marriage education programming and practitioners are outlined.     

Master'S degree programs in marital and family therapy: an evaluation of admission and program requirements*

Current legal and professional guidelines related to master's-level training programs in marriage and family therapy are reviewed. The admission and program requirements of 50 California-based programs are then evaluated in light of these standards. The data indicate that the reality of these training programs often departs significantly from the ideals and suggested standards of the field. It is recommended that the various national and state organizations interested in promoting quality marriage and family training programs collaborate with program representatives to establish more explicit and rigorous expectations for master's-level training.     

Effects of family planning and health services on women��s welfare: evidence on dowries and intra-household bargaining in Bangladesh

This paper demonstrates how the availability of family planning and maternal and child health services alters the structure of intra-household bargaining. The overall welfare gains from such programs are likely to be large, but when women obtain access to services only through marriage, some of these gains may be partially offset by changes in their bargaining power and in the dowries that they pay their husbands. I examine these marriage market effects using a family planning and health services program in rural Bangladesh, finding that compared to women without program access, women in the treatment area are 35% less likely to be able to make purchases without permission from their husbands or another household member. Moreover, a difference-in-difference specification confirms that women pay 14% higher dowries in order to obtain husbands with access to the program. The fact that adjustments are made both before and within marriage suggests that marital contracts in rural Bangladesh are negotiated along multiple margins.     

Experiences of Family Therapists Working with Families in a Transitional Homeless Community

The purpose of this study was to explore the experiences and observations of marriage and family therapists (MFTs) conducting an empirically supported parenting program at a transitional homeless community. A diary method was used in recording five MFTs' observations and reactions to implementing the psychoeducational groups. Fifty‐one recordings were collected from three different parenting groups over the course of 20 weeks. Constant comparative method was used to identify themes related to MFTs' experiences of conducting the parenting program. These themes included the needs of at‐risk families, confidentiality, and role ambivalence and boundary ambiguity. We provide recommendations for best practices and an example of therapists' decision‐making process using Kitchener's (1984) model.     

Human Sexuality Education in Marriage and Family Therapy Graduate Programs

Given the likelihood that marriage and family therapists will encounter clients with sexual concerns, it is important to know how graduate training programs are preparing future clinicians to work with this domain of life. Sixty‐nine marriage and family therapy (MFT) program directors completed an online survey to examine how sexual health education is integrated into graduate training programs. Findings indicate that while the majority of program directors value sexuality curriculum, and most programs require at least one course in this area, there are barriers to privileging sex topics in MFT graduate programs. Barriers include few MFT faculties with expertise in human sexuality and marginalized sexual health topics. Implications for training MFT graduate students and their work with future clients are discussed.     

Asian Families at the Crossroads: A Meeting of East,West, Tradition,Modernity, and Gender

East Asian societies have undergone major changes in the past few decades, including substantial declines in marriage and fertility. This article introduces the special section of Asian Families in Context by sketching commonalities and variations in patterns of marriage and family behavior in this region. A discussion of relevant theoretical frameworks from the Western literature follows. The final section briefly introduces the 6 empirical studies that comprise this section and discusses their relevance for developing and refining theory relevant to understanding family change in East Asia.     

Marriage and immigration enforcement: The impact of Secure Communities on immigrant women

We investigate if increased deportations under the Secure Communities (SC) program impacted the marriage patterns of immigrant women in the United States. We focus on country of origin-MSA deportation rates, arguing this is appropriate given the dominance of endogamous marriage among immigrants and large heterogeneity in removal rates. We find that rising deportations increased marriage rates and endogamous marriage, decreased exogamous marriage to immigrants from other countries, and had no impact on marriage to native-born men. This is striking because SC likely reduced same ethnicity partners in marriage markets. We find some evidence that increased network effects may explain these results.     

The role of marriage in linguistic contact and variation: Two Hmong dialects in Texas1

The role of marriage in linguistic contact and variation has been under‐represented in sociolinguistic research. In any practice‐based analysis, individual interactions and relationships are crucial. Therefore, marriage relationships – small but intense communities of practice – deserve variationist attention for their role in dialect construction and identity. This investigation of cross‐dialectal marriages explores how dialect practices and choices are negotiated between partners. The results show the importance of viewing this linguistic behavior in terms of community ideology, culture, and individual choice, rather than primarily as a matter of the amount and intensity of contact. Likewise, the study shows how less commonly studied minority communities can bring new insights to the study of dialect acquisition and linguistic contact. Specifically, this investigation focuses on marriages between speakers of two different dialects of Hmong, a Hmong‐Mien language of Southeast Asia. On the basis of home visits to ten Hmong immigrant households in Texas, the study analyzes lexical and phonetic contrasts and ethnographic interviews. Results suggest that macro‐level shifts in Hmong social organization and gender roles are being reflected and constructed by gendered, marriage‐level dialect practices. The linguistic behavior in these marriages is best viewed as a matter of community ideology in tension with individual choice: individual wives are choosing to challenge the traditional Hmong ideology regarding language behavior in cross‐dialect marriages.     

The Value of Premarital Education

Premarital education programs have been designed with the aim of helping prospective spouses examine and evaluate their relationship prior to marriage. It is widely considered as preventative skills training and assumes that exposing couples to the skills to improve their relationship will help them deal with interpersonal difficulties as they arise. Skills commonly included in the programs involve communication, negotiation, problem-solving and decision making. There are a number of problems identified with the current status of premarital education programs including the atheoretical nature of most programs, the lack of specific goals in the program format, and poor evaluation procedures which are used to examine effectiveness. Overall it is concluded that although the concept of preparation for marriage is a good one, the current value of these programs is limited. A personal account of one premarital education program is also provided.     

Marriage Migration Policy in South Korea: Social Investment beyond the Nation State

This article seeks to contribute to understandings of South Korea's approach to marriage migration. Situating our analysis of marriage migration policy specifically within the recent emergence of a social investment approach to welfare, we bring together two bodies of literature that due to the methodological nationalism of much welfare state scholarship are usually treated separately. Through an examination of the policy framework governing marriage migration ‐ so‐called ‘multicultural family policies’ ‐ we find that successive Korean governments have actively sought female marriage migrants to perform various social reproductive roles as a means to secure the reproductive capacity of the nation, just as feminist scholars have argued the care work of citizen‐mothers can be understood. Our analysis also suggests that marriage migration policy in Korea constitutes a distinctly transnational dimension to its overall social investment approach, which is strongly motivated by concerns to reproduce the next generation of human capital.     

The Development of a Physician Vitality Program: A Brief Report

We describe the development of an innovative program to support physician vitality. We provide the context and process of program delivery which includes a number of experimental support programs. We discuss a model for intervention and methods used to enhance physician resilience, support work‐life balance, and change the culture to one that explicitly addresses the physician's biopsychosocial‐spiritual needs. Recommendations are given for marriage and family therapists (MFTs) who wish to develop similar support programs for healthcare providers. Video Abstract     

Changing informal institutions via mimesis: Gender equality in marriage proposals

Marriage equality has exposed how the institution of marriage is changing, but less attention has been given to how informal institutions around heterosexual marriage rituals are affected by a growing demand for gender equality. By applying institutional theory and feminist institutionalism to the context of women proposing to their male partners, this paper observes how shifts in gender norms change heteronormative institutions. Drawing from interviews with women who proposed to men and a virtual ethnography, we describe how reverse proposals can set precedence for emulation of practices or mimetic isomorphism. We therewith contribute to institutional theory in threefold ways. First, we describe how mimetic isomorphism introduces new standards and norms into a highly traditional institution. Second, we show how this integration of new standards and norms serves this patriarchal institution to remain relevant and appear progressive. Finally, we contend that this tension of joining a patriarchal institution but doing so in a subversive manner represents a double bind for women who are encouraged by society to formalize their heteronormative relationships through marriage and yet chastised for initiating this themselves.     

A Mexico City-based immersion education program: training mental health clinicians for practice with Latino communities

This article describes the philosophical foundations and educational methods of a Spanish language and cultural immersion program based in Mexico City, Mexico. The program is designed to assist U.S. graduate students in marriage and family therapy and clinical psychology programs to improve clinical service delivery with Latino clients. Utilizing critical pedagogy, the program works with future clinicians to develop multicultural and international competencies; acquire increased Spanish language skills; engage in self-of-the-therapist work; and expand their understanding of the historical and cultural influences shaping the mental healthcare needs of Latin American clients. A report of the themes from postimmersion surveys is provided and the implications for training are discussed.     

Evaluating theory-based evaluation: information, norms, and adherence

Programmatic social interventions attempt to produce appropriate social-norm-guided behavior in an open environment. A marriage of applicable psychological theory, appropriate program evaluation theory, and outcome of evaluations of specific social interventions assures the acquisition of cumulative theory and the production of successful social interventions - the marriage permits us to advance knowledge by making use of both success and failures. We briefly review well-established principles within the field of program evaluation, well-established processes involved in changing social norms and social-norm adherence, the outcome of several program evaluations focusing on smoking prevention, pro-environmental behavior, and rape prevention and, using the principle of learning from our failures, examine why these programs often do not perform as expected. Finally, we discuss the promise of learning from our collective experiences to develop a cumulative science of program evaluation and to improve the performance of extant and future interventions.     

Cybersex and the E‐teen: What Marriage and Family Therapists Should Know

Adolescents who use the Internet regularly (the “e‐teen”) present a new set of challenges for marriage and family therapists. This article introduces marriage and family therapists to (a) the basic technological concepts and unique psychological characteristics of the Internet important in understanding and addressing adolescent online sexual behavior, (b) the appropriate developmental expectations for teens online, including risk‐taking behaviors and critical decision‐making skills, and (c) suggested strategies for assessment, prevention, and intervention when dealing with problematic online sexual behavior in adolescents. Marriage and family therapists cannot ignore the role the Internet plays in adolescent sexual development and its implication for the family. This article will serve as a primer for the marriage and family therapist when presented with adolescents who engage in online sexual behaviors.     

REVIEWS

Bailey, C. E. (Ed.) (2000). Children in therapy: Using the family as a resource. Doherty, W. J. (2001). Take back your marriage: Sticking together in a world that pulls us apart. New York: Guilford. Larson, J. H. (2000). Should we stay together? A scientically proven method for evaluating your relationship and improving its chances for long‐term success. Weiner‐Davis, M. (2001). The divorce remedy: The proven 7‐step program for saving your marriage.     

An Evaluation of the "Recovery of Hope" Program

The Recovery of Hope program was initiated in 1981 to address the problem of couples entering marriage enrichment events whose distress levels indicated a need for therapy rather than enrichment. An ex post facto evaluation was conducted for this divorce prevention program, surveying 190 spouses who had been involved in the program prior to October 1984. Returns were obtained from 34 wives and 27 husbands on post-test and retrospective pre-test marital satisfaction measures, along with a variety of other items and demographic data. Program completion appeared to assist couples in either improving their rclationship or in deciding to divorce, as opposed to continuing with an unsatisfactory marital relationship.