Maternal age at childbirth and perinatal and under-five mortality in a prospective birth cohort from Delhi

Abstract

Young motherhood is associated with an increased risk of post-perinatal mortality and measures to prevent early childbearing should be strengthened.

Women’s Marriage Age Matters for Public Health: A Review of the Broader Health and Social Implications in South Asia

“…The potential bi-directionality and multiple pathways of these associations also renders identification of the predictor and consequence difficult ( 45 ). For example, maternal age at childbirth, which is predicted by under-age marriage, is associated with infant mortality; these associations may operate through socio-economic deprivation and biological behavioral factors such as place of delivery, gestation, and birth-weight ( 59 , 71 ). But socio-economic deprivation and biological behavioral factors may themselves predict under-age marriage.…”

“…This study estimated that motherhood before age 18 years contributed to 11, 12, and 16% of infant mortality in these countries, respectively. Several studies find that the higher risk of dying around birth or in the month after birth, for the children of young mothers compared with those of older mothers, is almost entirely accounted for by the biological mediators of LBW and pre-term birth, but that the continued higher risks of dying later remain even when available biological, demographic, and socio-economic factors are controlled ( 70 , 71 ). This suggests that the child-care practices of young mothers might be affected through routes difficult to capture in the sort of surveys frequently used; routes which might include female autonomy and decision-making.…”

Moving beyond a maternal perspective to child survival

“…It is not clear to us if Sinha, et al [6] can examine this in their data; however, if they can, a supplementary follow-up analysis would be valuable to strengthen the interpretation of their study. Meanwhile, using the publicly available 3 rd Indian National Family Health Survey (NFHS) [16], we assessed the similarity in the effect size related to age at birth for both mothers and fathers on child mortality as well as child undernutrition.…”

“…Other maternal specific interventions that have received considerable attention in the literature include family planning and care targeted to mothers in the preconception period along with micronutrient and folic acid supplementation and early initiation of breastfeeding during pregnancy and in the postnatal period [5]. In this issue, Sinha, et al [6] consider maternal age at childbirth (hereafter referred to as maternal age) as a potentially modifiable social determinant of child survival within a large prospectively followed cohort. They report that young motherhood is associated with an increase in child mortality, leading to a conclusion that delaying age at pregnancy would confer important survival benefits in this population.…”

Counting stillbirths and achieving accountability: A global health priority

“…Many of the findings reported by Dandona et al [ 4 ] are well recognized risk factors for poor pregnancy outcomes, such as the association of stillbirths with poor quality of antenatal care (no antenatal care in 41% and 52% of urban or rural samples, respectively), small size of the fetus (25% and 38%), maternal fever in about 15%–16%, and evidence of infection in 15%–20% of subjects. No information is provided on the proportion of births among younger adolescents (<18 years), an important factor in the context of India, where adverse birth outcomes are associated with young maternal age [ 8 ]. Similarly, we do not have information specific on access to caesarean section deliveries in the cohort, as limited access to emergency caesarean sections is a recognized risk factor for stillbirths at the population level [ 5 ].…”