Early marriage and early childbearing in South Asia: trends, inequalities, and drivers from 2005 to 2018

Abstract

Early marriage (EM) and early childbearing (ECB) have far-reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever-married women aged 20-24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We find that EM/ECB are still common in Bangladesh (69%/69%), Nepal (52%/51%), India (41%/39%), and Pakistan (37%/38%), with large subnational variation in most countries. EM has declined fastest in India (AARR of-3.8%/year), Pakistan (-2.8%/year), and Bangladesh (-1.5%/year), but EM elimination by 2030 will not occur at these rates. Equity analyses show that poor, uneducated women in rural areas are disproportionately burdened. Regression decomposition analysis shows that improvements in wealth and education explained 44% (India) to 96% (Nepal) of the actual EM reduction. Investments across multiple sectors are required to understand and address EM and ECB, which are pervasive social determinants of maternal and child wellbeing.

Adolescent birth and child undernutrition: an analysis of demographic and health surveys in Bangladesh, 1996–2017

“…40 A major cause of adolescent pregnancies in Bangladesh is child marriage-that is, marriage before the legal age of 18 years old, which is highly prevalent in the country (∼70%). 6 Despite years of social movements to prevent child marriage in Bangladesh, the problem persists because of strong social norms in relation to religion, social pressure, perceived gendered roles of girls, maintenance of family honor and chastity of girls, pressure of a dowry, and concerns for safety and security. [41][42][43] Once married, couples are encouraged to have children because of perceptions that delaying the first birth after marriage could result in being a "childless woman," rumors of infertility, shame on the family, and loss of the husband because the husband's family wishing to seek another wife for their son.…”

“…5 In 2018, 69% of Bangladeshi women 20-24 years old had their first birth during adolescence (<20 years old). 6 It is well established that adolescence is a critical phase of social, physical, and cognitive development. 5,7 Pregnancy and birth during this phase has far-ranging consequences for the adolescent herself and for her child, including decreased maternal nutritional status, [8][9][10] poor access to nutrition and health services, 11,12 increased maternal morbidity and mortality, 13,14 and poor pregnancy and child outcomes.…”

“… 5 In 2018, 69% of Bangladeshi women 20–24 years old had their first birth during adolescence (<20 years old). 6 …”

Progress in reaching unvaccinated (zero-dose) children in India, 1992–2016: a multilevel, geospatial analysis of repeated cross-sectional surveys

“…To examine absolute trends in zero-dose prevalence, we computed the percentage change between surveys divided by the number of years between surveys. To examine relative trends, we calculated the average annualised rate of decline (AARD) using the equation: 16…”

“…To assess whether India is on track to meet the IA2030 zero-dose target of a 50% reduction in 2030 zero-dose prevalence from 2019 levels, we used the equation: 16 Where n represents the number of years between the NFHS-4 survey and 2030.…”