Role of child marriage on women’s nutritional status in adulthood

Abstract

Background: Child marriage, defined as marriage before the age of 18 years, could have detrimental impacts on women’s physical and psychological development affecting health outcomes in adulthood. This observational study aimed to examine whether women’s nutritional status, measured by body mass index (BMI) categories, was associated with being married in childhood. Methods: Using nationally representative repeated cross-sectional data on 822,642 married women, aged 20 to 49 years, from the 2015-16 and 2019-21 waves of India National Family Health Survey, we assessed the risk of underweight, overweight, and obesity conditions, relative to having BMI at the normal threshold, between women who were married as children and as adults. Results: Estimates of the baseline multinomial logistic regression model, without controlling for household wealth, showed that women married in childhood were 1.09 times more likely to be underweight and 7.5% and 8.3% less likely to be overweight or obese, respectively. However, when household wealth index quintiles were adjusted, women married as children were found 8.2% less likely to be underweight, and 1.12 and 1.23 times more likely to be overweight or obese, respectively. These results were robust across different birth cohorts and geographic region sub-groups and indicated a classic case of the Simpson’s paradox. Conclusion: We found that compared to women who were married as adults, women married in childhood had a higher risk of overweight and obesity. Our estimates of this relationship can play an important role in educating public health stakeholders and stimulating further research aimed at informing targeted policy interventions.