Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study

Type Journal Article - The Lancet
Title Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study
Volume 373
Issue 9678
Publication (Day/Month/Year) 2009
Page numbers 1883-1889
Child marriage in India is considered a major barrier to the nation's social and economic development, as well as a major women's health concern. The current study assesses prevalence of child marriage (i.e., marriage prior to the national legal age of 18 years) among young adult women in India, and associations between child marriage and women's fertility and fertility control behaviors.
Study Design
Cross-sectional analyses of a nationally representative household sample of Indian women ages 16-49 years (N=124,385) collected in 2005-2006 via the National Family Health Survey-3.
Analyses were restricted to women age 20-24 years (n=22,807) and the subsample of ever married women aged 20-24 years (n=14,628).
Data Analysis
Prevalence estimates of child marriage were produced for all women 20-24 years. Using the ever married subsample, simple regression models, models adjusted for demographics, and models adjusted for demographics and duration of marriage were constructed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between child marriage and both fertility and fertility control outcomes.
Fertility and Fertility Control Outcomes
No contraception prior to childbirth, childbirth within first year of marriage, high fertility (3 or more births), history of recent rapid repeat childbirth, unwanted pregnancy, and female sterilization.
Child marriage was reported by 44.5% of Indian women ages 20-24 years; 22.6% reported marriage prior to age 16 years, and 2.6% were married prior to age 13 years. Child marriage was significantly associated with women's increased risk for no contraceptive use prior to first childbirth (AOR=1.37, 95% CI=1.22, 1.54), high fertility (AOR=7.40, 95% CI=6.45, 8.50), history of rapid repeat childbirth (AOR=3.00, 95% CI=2.74, 3.29), multiple unwanted pregnancies (AOR=2.36, 95% CI=1.90, 2.94), pregnancy termination (AOR=1.22; 95% CI=1.06, 1.41) and female sterilization (AOR=5.54, 95% CI=4.86, 6.32) relative to women married at 18 years or older. Associations between child marriage and rapid repeat childbirth, multiple unwanted pregnancies, pregnancy termination and sterilization remained significant after controlling for duration of marriage.
Child marriage remains pervasive in India and is linked to high and less controlled fertility, as well as increased likelihood of termination and sterilization by young adulthood. While greater enforcement of existing policies are critical to preventing child marriage, education and support services regarding family planning for adolescent wives and their families are also clearly indicated in order to reduce the reproductive health consequences of this socially normative practice.

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