The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sampleBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.b4258 (Published 22 January 2010) Cite this as: BMJ 2010;340:b4258
- Anita Raj, associate professor1,
- Niranjan Saggurti, senior research associate2,
- Michael Winter, deputy director3,
- Alan Labonte, senior research associate4,
- Michele R Decker, research associate5,
- Donta Balaiah, scientist6,
- Jay G Silverman, associate professor5
- 1Boston University of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
- 2Population Council, New Delhi, India
- 3Boston University of Public Health, Data Coordinating Center, Boston
- 4Boston University School of Management, Department of Operations and Technology Management, Boston
- 5Harvard School of Public Health, Department of Society, Human Development and Health, Boston
- 6National Institute for Research in Reproductive Health, Indian Council for Medical Research, Mumbai, India
- Correspondence to: Anita Raj, Department of Social and Behavioral Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston MA 02118, USA
- Accepted 27 July 2009
Objective To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India.
Design Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations. Adjusted models included maternal and child demographics and maternal body mass index as covariates.
Population Women aged 15-49 years (n=124 385); data collected in 2005-6 through National Family Health Survey-3. Data about child morbidity and mortality reported by participants. Analyses restricted to births in past five years reported by ever married women aged 15-24 years (n=19 302 births to 13 396 mothers).
Main outcome measures In under 5s: mortality related infectious diseases in the past two weeks (acute respiratory infection, diarrhoea); malnutrition (stunting, wasting, underweight); infant (age <1 year) and child (1-5 years) mortality; low birth weight (<2500 kg).
Results The majority of births (73%; 13 042/19 302) were to mothers married as minors. Although bivariate analyses showed significant associations between maternal child marriage and infant and child diarrhoea, malnutrition (stunted, wasted, underweight), low birth weight, and mortality, only stunting (adjusted odds ratio 1.22, 95% CI 1.12 to 1.33) and underweight (1.24, 1.14 to 1.36) remained significant in adjusted analyses. We noted no effect of maternal child marriage on health of boys versus girls.
Conclusions The risk of malnutrition is higher in young children born to mothers married as minors than in those born to women married at a majority age. Further research should examine how early marriage affects food distribution and access for children in India.
Contributors: AR led conception of the study and interpretation of study findings, as well as drafting the manuscript. As guarantor, she accepts full responsibility for this submitted work, had access to the data, and controlled the decision to publish. NS is second author and contributor for this manuscript. He co-led conception and interpretation of study findings, and he assisted revising the manuscript for important intellectual content. MW led the analytic approach undertaken for this manuscript based on study conception, and he wrote pieces of the manuscript specific to measures, data, and data analysis. AL is a co-author and contributor for this manuscript. He co-led the analytic approach undertaken for this manuscript based on study conception, and he co-wrote pieces of the manuscript specific to measures, data, and data analysis. He also assisted in interpretation of study findings. MD assisted in revising the manuscript critically for important intellectual content. She has seen and approved this final submitted version. She will provide final approval of the version to be published. DB assisted in revising the manuscript critically for important intellectual content. JGS is senior contributor and consulted with AR and NS on study conceptualisation and interpretation of study findings. He revised the manuscript critically for important intellectual content. All authors have seen and approved this final submitted version of the manuscript. All authors will provide final approval of the version to be published.
Funding: Analyses for this study and development of this paper were funded by the US National Institutes of Health and the Indian Council on Medical Research Indo-US Program on Maternal and Child Health and Human Development (Grant Number 1 R03 HD055120-01), as well as seed grant funding from Boston University School of Public Health. Researchers operated independently from the funders on this work, and funders neither provided nor were required to provide review and approval of this research.
Competing interests: None declared.
Ethical approval: Because this manuscript involved secondary data analysis of a public dataset, ethics approval from our respective institutions was not required. All study authors were granted access to these data for the purpose of manuscript development.
Data sharing: Data used in this study were from a publically available dataset from MACRO Demographic and Health Surveys (DHS). Technical appendix, statistical code, and dataset can be obtained from MACRO DHS at www.measuredhs.com/countries/country_main.cfm?ctry_id=57&c=India.
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