Reproductive Outcomes Are Suboptimal Among Women Who Marry Early in India
Women in India who marry before age 18 are more likely than those who marry later to have high parity and inadequate birth spacing, according to a nationally representative study.1 Despite being outlawed in 1978, child marriage remains common in India: Nearly half of ever-married 20–24-year-olds in the study had married before reaching the legal age of 18. Even when duration of marriage was taken into account, such women were more likely than same-aged peers who married later to have not practiced contraception before their first birth (odds ratio, 1.4); to have had at least three births (1.3), short intervals between births (1.4) and multiple unintended pregnancies (1.4); and to have undergone sterilization (2.1).
The researchers analyzed data on 22,807 20–24-year-old women from the 2005–2006 India National Family Health Survey, a nationally representative, household-based study. Two-thirds of the sample (14,813 women) had ever been married; this subgroup formed the basis for most calculations. The researchers analyzed demographic data (including women's age, education level, marital status, age at marriage, area of residence and household wealth, and husband's age and education level), as well as information on the following reproductive characteristics: contraceptive use before first childbirth, childbirth in the first year of marriage, high lifetime fertility (three or more births), closely spaced births (<24 months apart), unintended pregnancy, pregnancy termination (by abortion, miscarriage or stillbirth) and sterilization.
The sample had a mean age of 22. Most women lived in rural areas (67%) and were Hindu (80%); one-third (31%) had no formal education, and three-quarters had ever been married. Some 45% of all respondents had married before age 18, 23% before age 16 and 3% before age 13. About one in seven ever-married women (14%) were at least 10 years younger than their husband.
Although women who had married before age 18 made up slightly less than half of the sample, they accounted for 72% of respondents with no education, 53% of those in rural areas and 70% of those in the lowest wealth quintile. Among ever-married women, child marriage was more common among those who were 10 or more years younger than their husband than among those whose husband was closer in age (66% vs. 57%); it was also more prevalent among women whose husband had no education than among those whose husband had some education (77% vs. 34%).
Nearly every reproductive health outcome—many of them adverse—was more prevalent among women who had married early than among their counterparts who had married later. For instance, 31% of women who had married early had had two closely spaced births, compared with 12% of those who had married as adults; 27% of respondents who had married before age 18 had had at least three children, compared with 4% of those who had married later. Nearly 20% of women who had married before age 18 reported having been sterilized (compared with 5% of women married later), and 10% of those who had both married early and undergone sterilization had had the procedure before age 18.
In a multivariate analysis that adjusted for demographic characteristics, women who had married before age 18 were more likely than those who had married in adulthood to report not having used contraceptives prior to their first birth (odds ratio, 1.4). In addition, even after the researchers controlled for both demographic variables and duration of marriage, women who had married before age 18 were more likely than those who had married later to have given birth three or more times (1.3) and to have had closely spaced births (1.4), multiple unwanted pregnancies (1.4) and a pregnancy termination (1.2). In addition, the odds of having undergone sterilization among women who had married before age 18 were twice those of women who had married later (2.1).
These findings "strongly indicate that the social context of child marriage reduces women's control of their reproduction in adulthood, possibly because of less contraception knowledge, poor access to family-planning services, reduced control of family-planning decisions in marriages to older men, and heightened control by in-laws," according to the researchers, who add that the ill effects of early marriage also include heightened risks of maternal and infant mortality. They suggest addressing the problem of underage marriage and its association with poor fertility control by expanding "family planning programs tailored to married adolescents," and ensuring that interventions target men who might marry adolescents, women already in early marriages, and the husbands and in-laws of women who married as adolescents. The researchers also posit that programs to address gender inequality will help improve the position of girls in India, "such that child marriage is not the only economically feasible and socially acceptable option for many impoverished families."—H. Ball
1. Raj A et al., Prevalence of child marriage and its effects on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study, Lancet, 2009, 373(9678):1883–1889.