Motherhood in childhood: addressing reproductive health hazards among adolescent married women in India

Abstract

BackgroundIn India, due to the high prevalence of child marriage, most adolescent pregnancies occur within marriage. Pregnancy and childbirth complications are among the leading causes of death in girls aged 15 to 19 years. Hence, adolescent pregnancy is a serious health threat to young women in India.MethodsThe study focuses on the level and trends of adolescent pregnancy rate (per thousand currently married adolescent women) in India in the last two decades, based on cross-sectional data from three different periods, DLHS-1 (1998–99), DLHS-2 (2002–04) and DLHS-3 (2007–08). Further, the determinants of adolescent pregnancy and its effects are analyzed using the DLHS-3 data, which used a multi-stage stratified systematic sampling design. The sample size of this study was 18,709 pregnancies that occurred to 14,006 currently married adolescent (15–19 years) women. Chi-square tests and logistic regression were used to examine the association between pregnancy outcomes (live birth vs. abortion/stillbirth) and health complications with socioeconomic variables and maternal-child health (MCH) service utilization.ResultsDuring the periods of 1998–99, 2002–04 and 2007–08, the rate of adolescent pregnancy was 427, 467 and 438 respectively. In 2007–08, the proportion of live births (vs. stillbirth or abortion) was significantly higher among older adolescents aged 18–19 years (OR = 1.25, 95 % CI (1.08–1.44), p < 0.001) than among younger adolescent women of 15–17 years. The proportion of live births was also higher among women having 10 years or more education (OR = 1.26, 95 % CI (1.01–1.56), p < 0.01). The prevalence of live birth was significantly higher among women who had received some delivery advices (OR = 1.38, 95 % CI (0.96–1.95), p < 0.01), had consumed iron/folic acid tablets, (OR = 1.37, 95 % CI (0.89–2.11), p < 0.05), had received Tetanus Toxoid injection (OR = 2.29, 95 % CI (1.25–4.19), p < 0.001), while those with assisted vaginal delivery were significantly less likely to have a live birth (OR = 0.38,95 % CI (0.21–0.68), p < 0.001). Adolescent women had 66.6 % delivery complications (i.e. any one problem) vs. 62.5 % among adult women (20–24 years), (p < 0.001).ConclusionStillbirth and abortion are more prevalent among younger adolescents than among older adolescents, and among all adolescents than among adult women. Delaying the first birth until age 20 appears to benefit both mothers and babies. Access to reproductive health services; timely and quality family planning services and safe abortion and delivery advice; tetanus toxoid and iron/folic acid for those married adolescents who do become pregnant could improve health outcomes.

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“…In Nigeria 11,27,28 and other parts of the world, 3,29 raising levels of education delays age at marriage and age at first delivery while increasing opportunities for better paying jobs. Studies in India, 30 Kenya 31 and elsewhere 32 have demonstrated that delaying child bearing until women are between the age of 20 -30 years was reported to have a fourfold lower risk of dying from pregnancy related complications compared to those less than 20 years old. Furthermore, women in the developed countries delay child bearing and have few number of children compared to the high fertility rate of 5 or more in the sub-Saharan African countries.…”

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“…Adolescent pregnancy or 'motherhood in childhood' is one of the gravest health hazards to young women in India. Patra S et al had observed that stillbirth and abortion were more widespread among younger adolescents and the proportion of live births (vs. stillbirth or abortion) was also advanced among women having 10 years or more education [ 21 ]. As per UNFPA, the girl with adolescent pregnancy bears end of her education along with shrinking away from her job prospects and her vulnerability to poverty and exclusion increases [ 22 ].…”

Assessing the effect of the Samata intervention on factors hypothesised to be on the pathway to child marriage and school drop-out: results from a cluster-randomised trial in rural north Karnataka, India

“…3 Child brides are more likely to experience physical or sexual intimate partner violence, to face health risks from early pregnancy, and to leave education early. [4][5][6] In addition to economic benefits, participation in secondary education is strongly associated with reductions in adolescent birth rates, mortality rates among 15-19 year old boys and girls, and maternal mortality among 15-24 year olds. 3 While there has been significant progress in recent years in increasing enrolment and retention in primary school, among those countries with available data, India has the highest number of out-of-school adolescents, globally, with 11.1 million adolescents of lower secondary school age and 46.8 million of upper secondary age estimated to be out-of-school in 2013.…”