Social, biological, and programmatic factors linking adolescent pregnancy and early childhood undernutrition: a path analysis of India's 2016 National Family and Health Survey

Abstract

Summary Background Adolescent pregnancy and child undernutrition are major social and public health concerns. We aimed to examine associations between adolescent pregnancy and child undernutrition in India, where one in five adolescents live, and one in three of the world's stunted children. Methods Data were from India's fourth National Family Health Survey, 2015–16. Primiparous women aged 15–49 years who gave birth between 2010 and 2016 were classified on the basis of age at first birth: 10–19 years (adolescence), 20–24 years (young adulthood), and 25 years or older (adulthood). Primary outcomes were anthropometric measures of offspring undernutrition. Multivariable regression and structural equation models were used to understand the extent to which these measures were linked to adolescent pregnancy and the potential social, biological, and programmatic pathways. Findings Of the 60 096 women in the sample, 14 107 (25%) first gave birth during adolescence. Children born to adolescent mothers had lower Z scores for length or height-for-age (mean difference −0·53 SD), weight-for-age (–0·40 SD), and weight-for-length or height (–0·16 SD) than children born to adult mothers. Compared with adult mothers, adolescent mothers were shorter (–1·21 cm, 95% CI −1·78 to −0·65), more likely to be underweight (18 percentage points, 15–21) and anaemic (8 percentage points, 6–11), less likely to access health services (–4 to −15 percentage points), and had poorer complementary feeding practices (–3 to −9 percentage points). Adolescent mothers also had less education (–3·30 years, 95% CI −3·68 to −2·91), less bargaining power (–7 to −15 percentage points), and lived in poorer households (–0·66 SD, 96% CI −0·82 to −0·50) with poorer sanitation (–28 percentage points, −32 to −24). In the path analysis, these intermediate factors predicted child anthropometry, with the strongest links being mother's education (18%), socioeconomic status (13%), and weight (15%). Interpretation Children born to adolescent mothers are at risk of being undernourished. Adolescent pregnancy is related to child undernutrition through poor maternal nutritional status, lower education, less health service access, poor complementary feeding practices, and poor living conditions. Policies and programmes to delay pregnancy and promote women's rights could help break the intergenerational cycle of undernutrition through many routes. Funding Bill & Melinda Gates Foundation through Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India, led by the International Food Policy Research Institute.

A cross-sectional study on selected child health outcomes in India: Quantifying the spatial variations and identification of the parental risk factors

“…Similarly, the likelihood is observed to be low for stunting as well as for no/partial immunization among those children whose parents are older (aged 25 years or more) compared to the children of younger parents. Previous study linked early age pregnancy and the risk of being malnourished among the children born to the adolescent mothers 44 . Adolescence pregnancy, and mother's own nutritional status during pregnancy and during her life course plays an important role in the birth outcome and substantially determines birth weight of the new born 44 .…”

“…Previous study linked early age pregnancy and the risk of being malnourished among the children born to the adolescent mothers 44 . Adolescence pregnancy, and mother's own nutritional status during pregnancy and during her life course plays an important role in the birth outcome and substantially determines birth weight of the new born 44 . In this direction, the evidence show that the children of the young mothers/parents are vulnerable to be at the risk of poor nutritional health-stunted or anaemic.…”

What lies at the root of child undernutrition in India? Understanding trends and patterns in underlying determinants between 2006 and 2016

“…Evidence shows that children born to adolescent mothers are more likely to be undernourished than those born to adult mothers (Nguyen et al, 2019). Despite the legal mandate for minimum age at marriage, even in 2016 almost 1 in 4 women were married before the age of 18.…”

Adequação da atenção pré-natal e restrição do crescimento intrauterino na coorte de nascimento de Ribeirão Preto de 2010 (Coorte BRISA)

“…Entre esses estudos, Coimbra, et al (2003) encontraram no índice APNCU apenas 10% de adequação, enquanto para o novo índice proposto a adequação foi de 49,6%. Ao contrário, no estudo de Leal, et al (2014) (NETO, et al, 2012;VIELLAS, et al, 2014;GUIMARÃES, et al, 2018 Apesar da tendência crescente na redução da gravidez na adolescência observada em todas as regiões brasileiras (BURATTO, et al, 2019), ainda assim é um problema de saúde pública, e está associada com maior frequência às complicações maternas e neonatais (REXHEPI, et al, 2019;NGUYEN, et al, 2019), ao pior acesso aos serviços de saúde, bem como ao baixo comparecimento para o acompanhamento pré-natal. Além disso, deve-se considerar e compreender o cenário social e econômico em que as adolescentes estão inseridas.…”

“…Estudos mostram que o perfil das adolescentes grávidas é principalmente retratado pela baixa escolaridade, baixa renda e, em alguns casos, a ausência do companheiro (DEMIRCI, et al, 2016;NGUYEN, et al, 2019), inclusive, perfil similar ao encontrado no presente estudo. Essas características descritas, e enfatizando os achados para idade e escolaridade, podem influenciar e serem determinantes na decisão da adolescente quanto à adesão aos cuidados e acompanhamento pré-natal, mudanças nos hábitos de vida e alimentares, ao autocuidado, e ao amadurecimento para responsabilidades que a maternidade exige.…”