1
|
Vikram K, Visaria A, Ganguly D. Child marriage as a risk factor for non-communicable diseases among women in India. Int J Epidemiol 2023; 52:1303-1315. [PMID: 37159526 DOI: 10.1093/ije/dyad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Kriti Vikram
- Department of Sociology and Anthropology, National University of Singapore, Singapore
| | - Abhijit Visaria
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Dibyasree Ganguly
- Centre for the Study of Regional Development, Jawaharlal Nehru University, India
| |
Collapse
|
2
|
Tiwari A, Datta BK, Haider MR, Jahan M. The role of child marriage and marital disruptions on hypertension in women - A nationally representative study from India. SSM Popul Health 2023; 22:101409. [PMID: 37132019 PMCID: PMC10149281 DOI: 10.1016/j.ssmph.2023.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/14/2023] [Accepted: 04/16/2023] [Indexed: 05/04/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, 1120 15th Street, CJ 2300, Augusta, GA, 30912, USA
- Corresponding author.
| | - Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, 1120 15th Street, CJ 2300, Augusta, GA, 30912, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Wright Hall 301B 100 Foster Rd, Athens, GA, 30602, USA
| | - Murshed Jahan
- Langdale College of Business Administration, Valdosta State University, 1500 N. Patterson St, Valdosta, GA, 31698, USA
| |
Collapse
|
3
|
Algur K, Sakpal R. Premature menopausal women and risk of cardiovascular diseases in India: Longitudinal Aging Study in India, 2017-18. Health Care Women Int 2022:1-13. [PMID: 36369776 DOI: 10.1080/07399332.2022.2141745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
Women who have premature menopause are increasing in number and there is a wide regional diversity across the World, including India. However, in India, the relationship between age at menopause and cardiovascular diseases is still unclear. To fill this research gap, we undertook the present study using data from the Longitudinal Aging Study of India (Wave1, 2017-18). Bivariate logistic regression with three different models controlling for socio-economic and demographic characteristics, reproductive history, nutritional status, and co-morbidities of CVDs was used to show the relationship between CVDs and premature menopause. In all three models, the adjusted odds of having CVDs were higher for premature menopausal women than for those who had menopause between the ages of 45-50. There is a need to understand menopausal problems and their risk factors. The government should initiate a reproductive and sexual health awareness program at the macro level and provide treatment for the same.
Collapse
Affiliation(s)
- Kisan Algur
- International Institute for Population Sciences, Mumbai, India
| | - Ruchita Sakpal
- International Institute for Population Sciences, Mumbai, India
| |
Collapse
|
4
|
Assis TDSC, Martinelli KG, Gama SGND, Santos Neto ETD. Recurrence of teenage pregnancy: associated maternal and neonatal factor outcomes. CIENCIA & SAUDE COLETIVA 2022; 27:3261-3271. [PMID: 35894336 DOI: 10.1590/1413-81232022278.00292022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
The present study aims to analyze the socioeconomic and demographic factors associated with the recurrence of teenage pregnancy, as well as to verify the association with unfavorable maternal and neonatal outcomes. It is a cross-sectional study, based on data from "Nascer no Brasil", comprised of adolescent mothers and their newborns. Univariate and multiple logistic regression were used to indicate the factors associated with this recurrence. Recurrence of teenage pregnancy was associated with a maternal age of 17-19 years (OR=3.35; 95%CI=2.45-4.59); an inadequate education for their age (OR=4.34; 95%CI=3.50-5.39), with no intention of becoming pregnant; residency in the state capital; and the fact that the partner is the head of the family. However, as independent primiparous teenagers, there is a greater chance of hypertension and restricted intrauterine growth. It can therefore be concluded that there is a high percentage of teenage pregnancies in Brazil. Teenagers with a partner, inadequate education, and no reproductive planning are more likely to have two or more pregnancies before the age of 20, demonstrating difficulties in postponing the first pregnancy. However, as primiparous teenagers, they are more likely to have complications than multiparous teenagers.
Collapse
Affiliation(s)
- Thamara de Souza Campos Assis
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Medicina Social, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29040-090 Vitória ES Brasil.
| | - Katrini Guidolini Martinelli
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Medicina Social, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29040-090 Vitória ES Brasil.
| | | | - Edson Theodoro Dos Santos Neto
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Medicina Social, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29040-090 Vitória ES Brasil.
| |
Collapse
|
5
|
Assis TDSC, Martinelli KG, Gama SGND, Santos Neto ETD. Recurrence of teenage pregnancy: associated maternal and neonatal factor outcomes. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022278.00292022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The present study aims to analyze the socioeconomic and demographic factors associated with the recurrence of teenage pregnancy, as well as to verify the association with unfavorable maternal and neonatal outcomes. It is a cross-sectional study, based on data from “Nascer no Brasil”, comprised of adolescent mothers and their newborns. Univariate and multiple logistic regression were used to indicate the factors associated with this recurrence. Recurrence of teenage pregnancy was associated with a maternal age of 17-19 years (OR=3.35; 95%CI=2.45-4.59); an inadequate education for their age (OR=4.34; 95%CI=3.50-5.39), with no intention of becoming pregnant; residency in the state capital; and the fact that the partner is the head of the family. However, as independent primiparous teenagers, there is a greater chance of hypertension and restricted intrauterine growth. It can therefore be concluded that there is a high percentage of teenage pregnancies in Brazil. Teenagers with a partner, inadequate education, and no reproductive planning are more likely to have two or more pregnancies before the age of 20, demonstrating difficulties in postponing the first pregnancy. However, as primiparous teenagers, they are more likely to have complications than multiparous teenagers.
Collapse
|
6
|
Early Marriage in Adolescence and Risk of High Blood Pressure and High Blood Glucose in Adulthood: Evidence from India. WOMEN 2022. [DOI: 10.3390/women2030020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adolescence, the transition phase to adulthood, is a critical period for physical and psychological development. Disruptions during this period, such as getting married, could result in various adverse short- and long-term health outcomes. This study aimed to assess the differential risk of two common chronic conditions—high blood pressure and high blood glucose—in adult women (20–49 years) who were married during different stages of adolescence (10–19 years) compared to women who were married in their youth (20–24 years). Using the most recent nationally representative data from India, we separately assessed the odds in favor of having the two chronic conditions for women who were married during early (10–14 years), middle (15–17 years), and late (18–19 years) adolescence. We found that an earlier age at marriage during adolescence was associated with a higher risk of chronic conditions later in life. Women who were married during early adolescence were respectively 1.29 and 1.23 times more likely (p < 0.001) to have high blood pressure and high blood glucose compared to women who were married in their youth. These findings highlight the importance of preventing underage marriage among adolescent females to address the risk of downstream chronic health consequences as adults.
Collapse
|
7
|
The risk of hypertension among child brides and adolescent mothers at age 20 s, 30 s, and 40 s: Evidence from India. J Hum Hypertens 2022:10.1038/s41371-022-00730-9. [DOI: 10.1038/s41371-022-00730-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022]
|
8
|
Exarchos LM, Markantes GK, Stamou MI, Michail G, Androutsopoulos G, Kaponis A, Adonakis G, Georgopoulos NA. Teenage pregnancies in Western Greece: experience from a university hospital setting. Hormones (Athens) 2022; 21:127-131. [PMID: 34825311 DOI: 10.1007/s42000-021-00337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Teenage pregnancies have consistently been associated with preterm labor in a wide range of studies. Evidence regarding the incidence and potential complications of teenage pregnancies in Greece is at present scarce. The aim of this study was to evaluate the perinatal outcomes as well as the risk of perinatal and obstetric complications of teenage pregnancies. METHODS This retrospective study was conducted at the Department of Obstetrics and Gynecology of the University Hospital of Patras, Greece, and all data recorded concerned the year 2019 (January-December). We retrospectively reviewed 643 cases of singleton pregnancies divided into two groups, as follows: Group A included women of average maternal age (AMA) (20-34 years old), and Group B included teenagers, defined as women less than 20 years old. Data regarding demographic and pregnancy characteristics as well as obstetric and neonatal complications were collected. RESULTS Teenage pregnancies accounted for 6.7% of all deliveries. We detected significantly higher rates of preterm births (p = 0.025), primiparity (p < 0.001), and negative marital status (p < 0.001) in teenage mothers compared to pregnant women of AMA. There were no significant differences concerning other factors between the two groups. CONCLUSIONS The findings of the present study raise concern regarding the perinatal, obstetric, and social consequences of teenage pregnancies in Greece. Extended studies that will include further information on antenatal care and detailed socioeconomic factors (i.e., level of education, income, and ethnicity) are required to formulate reliable conclusions concerning teenage pregnancies and their effect on maternal and neonatal health.
Collapse
Affiliation(s)
- Lida-Maria Exarchos
- Department of Obstetrics and Gynecology, University of Patras School of Health Sciences, Patras, Greece
| | - Georgios K Markantes
- Division of Endocrinology-Department of Internal Medicine, University of Patras School of Health Sciences, Rio-Patras, Greece
| | - Maria I Stamou
- Division of Endocrinology-Department of Internal Medicine, University of Patras School of Health Sciences, Rio-Patras, Greece
| | - Georgios Michail
- Department of Obstetrics and Gynecology, University of Patras School of Health Sciences, Patras, Greece
| | - Georgios Androutsopoulos
- Department of Obstetrics and Gynecology, University of Patras School of Health Sciences, Patras, Greece
| | - Apostolos Kaponis
- Department of Obstetrics and Gynecology, University of Patras School of Health Sciences, Patras, Greece
| | - George Adonakis
- Department of Obstetrics and Gynecology, University of Patras School of Health Sciences, Patras, Greece
| | - Neoklis A Georgopoulos
- Division of Endocrinology-Department of Internal Medicine, University of Patras School of Health Sciences, Rio-Patras, Greece.
| |
Collapse
|
9
|
Datta B, Tiwari A, Glenn L. Stolen childhood taking a toll at young adulthood: The higher risk of high blood pressure and high blood glucose comorbidity among child brides. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000638. [PMID: 36962354 PMCID: PMC10021810 DOI: 10.1371/journal.pgph.0000638] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/20/2022] [Indexed: 01/28/2023]
Abstract
Despite notable progress being made in preventing child marriage, a significant proportion of women worldwide are still married before reaching adulthood. Though many aspects of child marriage have been widely studied, little is known on the later life health outcomes of child brides, let alone the critical need for healthcare during adulthood. This paper examines whether child brides at a young adult age bear a greater risk of high blood pressure (HBP) and high blood glucose (HBG) comorbidity than those who were married as adults. Using nationally representative data from India, we categorized married young adult (aged 20-34 years) women in four categories: neither HBP nor HBG, HBP only, HBG only, and both HBP and HBG. We estimated multinomial logistic regressions to obtain unadjusted and adjusted relative risk ratios in favor of these mutually exclusive outcomes for the child marriage indicator. Around 0.5% of the women in our sample had high blood pressure and high blood glucose comorbidity. While the prevalence of comorbidity was 0.4% among women who were married as adults, comorbidity was 40% higher (p < 0.000) among women who were married as children. The relative risk of the comorbidity among child brides was 1.4 (95%CI: 1.2-1.7) times that of their peers who were not married as children. The findings, thus, suggest that child brides at young adult age are at greater risk of having high blood pressure and high blood glucose comorbidity. Concerted public health efforts, therefore, are necessary to improve their long-term health and wellbeing.
Collapse
Affiliation(s)
- Biplab Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, United States of America
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, United States of America
| | - Lynn Glenn
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, United States of America
- Department of Biobehavioral Nursing, College of Nursing, Augusta University, Augusta, GA, United States of America
| |
Collapse
|