The risk of hypertension among child brides and adolescent mothers at age 20 s, 30 s, and 40 s: Evidence from India

Child marriage as a risk factor for non-communicable diseases among women in India

BACKGROUND

Child marriage, defined as marriage under the age of 18 years, remains pervasive in India. Global evidence documents a negative association between child marriage and women's reproductive and sexual health outcomes; however, its relationship with non-communicable diseases (NCDs) remains underexplored.

METHODS

We utilize biomarkers and self-reported data from the nationally representative National Family and Health Survey 4 (2015-2016) to examine the associations between child marriage and hypertension, diabetes, heart disease, asthma and thyroid disorder among currently married women (N = 421 107). We use regression models adjusted for a range of demographic and socio-economic controls to assess the association between child marriage and NCDs among women in India. We further assess whether and to what extent these relationships are mediated by early motherhood using the Karlson, Holm and Breen method of decomposition.

RESULTS

Child marriage was associated with hypertension [adjusted odds ratio 1.20 (95% CI: 1.17-1.24)], diabetes [1.29 (1.22-1.37)], heart disease [1.27 (1.18-1.36)], asthma [1.19 (1.11-1.28)] and thyroid disorder [1.10 (1.02-1.18)]. Early motherhood also increased the risk of NCDs among women. Furthermore, it emerged as a pathway linking child marriage with hypertension, diabetes and heart disease; however, it provided a partial explanation for the disadvantage associated with child marriages.

CONCLUSIONS

Child marriage emerges as a risk factor for NCDs among women in India. Health systems need to recognize the enduring influence of child marriages on women's health and ensure early detection and effective treatment of NCDs for this vulnerable group.

The role of child marriage and marital disruptions on hypertension in women - A nationally representative study from India

Child marriage is associated with negative health trajectories among women in low- and middle-income countries (LMICs). Marital disruptions in LMICs are also associated with adverse socioeconomic and health outcomes in women. Yet, little is known about the compounded health effects of experiencing both child marriage and marital disruptions. Using nationally representative data from India among women aged 18-49 years, we examined the effects of marital age (i.e., marriage before or after 18 years) and martial disruptions (i.e., widowed/divorced/separated) on the odds of having hypertension. Findings suggest that together, marital disruptions and child marriage increase the risk of hypertension. Specifically, women married as children and who experienced marital disruptions were 1.2 (95% CI: 1.2-1.3) times more likely to have hypertension compared to women who married as adults and currently in marriage. Additionally, among women married as children, those who experienced martial disruptions had a higher risk (AOR = 1.1, 95% CI: 1.0-1.2) of hypertension compared to their currently married peers. These results suggest public health strategies must consider contextual effects of being widowed/divorced/separated among women who were married as children. Simultaneously, prevention initiatives should be strengthened to reduce the incidence of child marriage in LMICs and associated downstream health consequences.

Child Marriage and Later-Life Risk of Obesity in Women: A Cohort Analysis Using Nationally Representative Repeated Cross-Sectional Data from Tajikistan

Child marriage, defined as union before age 18 years, has detrimental health and socioeconomic consequences. This study examines whether women married as children have a disproportionately higher risk of being obese at adulthood compared to their peers married as adults. Using data from the 2012 and 2017 waves of the Tajikistan Demographic and Health Survey, we matched women aged 25 to 49 years by birth year and month to create four birth cohorts. We fitted multivariable logistic regressions to assess the differential odds of being obese and estimated simultaneous quantile regression models to examine the differences in average body mass index (BMI) between women married as adults and as children within birth cohorts. We found that the adjusted odds of being obese for women married as children were 1.5 (CI: 1.3–1.7) times those of those who were married as adults, after controlling for sociodemographic correlates along with birth cohort and survey wave fixed effects. Results of the quantile regression analyses suggest higher expected BMI levels among women married as children compared to those of women married as adults across different quantiles of BMI. The differences though were more pronounced in the younger cohorts than in the older cohorts.

Child Marriage and Problems Accessing Healthcare in Adulthood: Evidence from India

The association between child marriage and the access to or utilization of maternal and antenatal healthcare has been widely studied. However, little is known about child brides' access to healthcare for illnesses later in life. Using data on 496,283 married women aged 18 to 49 years from the India National Family and Health Survey 2015-2016, we developed an 11-point composite score (ranging from 0 to 10) outlining the extent of problems accessing healthcare, as follows: (i) no/little problem (score 0 to 2), (ii) some problems (score 3 to 6), and (iii) big problems (score 7 to 10). The differences between child brides and their peers married as adults were assessed by the relative risk ratios obtained from multinomial logistic regressions. The adjusted risk of having "some problems" and "big problems" accessing healthcare relative to "no/little problem" for child brides was found to be 1.22 (95% CI: 1.20-1.25) and 1.26 (95% CI: 1.22-1.29) times that of those married as adults, respectively. These findings highlight the disproportionate barriers to healthcare access faced by women married as children compared to women married as adults and the need for further research to inform policies regarding effective public health interventions to improve healthcare access.